Understanding Stroke with Dr. Laurel Cherian

Episode Transcript

Dr. Correa:
From the American Academy of Neurology. I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters. And this is the Brain & Life Podcast. On this podcast, on our Brain & Life Podcast, we like to raise awareness and sometimes awareness comes from multiple different directions. What we're going to talk about today actually happened yesterday. It was World Stroke Day. We actually got several listeners and from stroke survivors, from caregivers, from loved ones of stroke survivors asking questions about stroke. So we decided to sort of raise awareness on this day after World Stroke Day, and we actually brought a wonderful expert to help us. Dr. Laurel Charian, who is an Associate Professor in the Department of Neurological Sciences at Rush University Medical Center, will be helping us answer those questions for you on stroke. So I hope you enjoy this episode and I want you to remember to be fast. That's going to be something we're going to learn today about stroke awareness.
Hello, Brain & Life Podcast audience, and thank you again for joining us today. So in addition to sort of raising your stroke awareness about stroke symptoms, we also wanted to answer some of your questions so we have an extra special guest today. We actually brought in a medical expert, Dr. Laurel Charian. Dr. Laurel Charian is an Associate Professor in the Department of Neurological Sciences at Rush University Medical Center. She serves also as the Assistant Dean of Advising and Medical Student Affairs for Rush Medical College. She's also the Medical Director of the Comprehensive Stroke Center at Rush University. In addition to her clinical practice, she's completed a master of science degree in clinical research and is very interested in acute stroke therapies, post-stroke, cognitive dysfunction and depression, and the role of nutrition and lifestyle modifications on post-stroke outcomes. We are delighted that she is going to be our expert today. Welcome to the Brain & Life Podcast.

Dr. Charian:
Thank you so much for having me. I'm excited to be here.

Dr. Peters:
And so we just heard the train pop by your window, I guess. So can you tell us where you're located and where that train's at?

Dr. Charian:
Yeah, I am in downtown Chicago and take care of stroke patients in Chicago and we also have a big telestroke network that reaches out into Northwest Indiana and downstate Illinois as well.

Dr. Peters:
Thank you so much for telling us that. And we may hear the training in the background, but I love Chicago. It's one of my favorite towns. My dad's from the south side, so always love to hear from all the Chicago folks. So stroke is a very common and serious disorder with someone having a stroke every 40 seconds. Now, can you just give us the basics for our listeners, like, what defines a stroke?

Dr. Charian:
So a stroke is a neurologic deficit that's related to the blood supply to the brain, and that can be a blockage kind of stroke, an ischemic stroke, or that can be from a ruptured blood vessel, which is a hemorrhagic stroke.

Dr. Peters:
Okay. And what are some of the risk factors for stroke?

Dr. Charian:
So some of the most powerful risk factor for stroke is blood pressure, but a lot of other factors as well, like diabetes, high cholesterol and lifestyle factors also in terms of a sedentary lifestyle, poor diet all play into increasing stroke risk.

Dr. Peters:
And sometimes I hear people also use the terminology a TIA or transient ischemic attack. How does that differ from a stroke and how is that defined?

Dr. Charian:
So the thing that differentiates a TIA from a stroke is permanent damage to the brain. So with a stroke, there's actually an infarct or damaged tissue that's permanent, whereas a TIA, transient ischemic attack by definition is transient. It goes away and most TIAs are 10 minutes or less, but the formal definition is under 24 hours and then you have a resolution of those symptoms. But from a practical standpoint, I kind of think of a TIA as your body firing a warning shot and it could have been a stroke. And so all of those risk factors I just mentioned for stroke are also risk factors for TIA. So regardless of whether it was a TIA and sort of a near miss and there's no permanent damage or whether there actually is a stroke and there is some damaged tissue that is permanent, either way, we're going to approach that similarly in getting those vascular risk factors under control and being really aggressive about preventing something from happening again in the future.

Dr. Peters:
I think that's so key. Prevention is so important and I'm always telling my patients it's blood pressure, blood pressure, blood pressure, and then I start listing the other ones. But they're all important. I mean, I think you've really hit that point home. Now, what are some of the first signs and symptoms of a stroke and how can we be aware on what was World Stroke Day?

Dr. Charian:
Yeah, this is so important. If there's one thing you take home from listening to this podcast, it's knowing these signs and symptoms of stroke because it's time sensitive. So if you recognize those symptoms early and you call 911 and come into the hospital frequently, we can treat you fast enough to either minimize or potentially reverse those stroke symptoms as they're happening. And the American Heart Association has a great mnemonic, really easy to remember called BE FAST. And the B is for balance. So suddenly losing coordination, the E is for eye movement.
So trouble seeing, you have a blacking out of your vision, blurred or double vision. F is for face, so facial drooping on one side. You can ask the person to smile or if you're by yourself, you can look in the bathroom mirror and see, does one side look droopy compared to the other. A is for arm, so numbed arm weakness or numbness. So if you put your arms out in front of you and one arm is drifting down, that's a problem. The S is for speech, so slurred or absent speech, just saying a simple sentence out loud and then the T is for time. So any of those previous things and then it's time to call 911. Okay. And that's going to get you to the right place at the right time. Our ambulance drivers, the emergency medical services are trained to take stroke patients to a hospital that is specially equipped to treat stroke symptoms.

Dr. Peters:
That's great. And I think it's BE FAST.

Dr. Charian:
BE FAST.

Dr. Peters:
So we just have to remember this. So it's Balance. Am I right?

Dr. Charian:
Yep.

Dr. Peters:
Eye movements, Face, A is-

Dr. Charian:
Arms.

Dr. Peters:
... arms. I should have [inaudible 00:07:06]. S is speech and T-

Dr. Charian:
T is time to call 911.

Dr. Peters:
Time to call 911. It's so important. And also, as we mentioned before when I was first talking to you, you have reached out to not just in Chicago itself, but also in those rural settings, what can they do in those rural settings if they are not close to a big hospital like Rush?

Dr. Charian:
So really the same. BE FAST is symptom recognition and calling 911 is still going to get you to a hospital that is at least able to give clot busting drugs typically. And then frequently if there's not a big hospital in your town, sometimes that means being in a helicopter and going to a bigger hospital if you need to have surgery to pull a clot out and get that blood vessel open. But the best bet is still recognizing those symptoms with that BE FAST mnemonic and then calling 911.

Dr. Peters:
BE FAST. And you mentioned that with those clot busting drugs, there are acute treatments for stroke, so people need to get there. What are some of the other sort of revolutionary treatments that can happen at Rush?

Dr. Charian:
Yeah, so you mentioned clot busting drugs. So tenecteplase or TNK is one of our mainstays for medical management. And then another big intervention treatment that we do is something called mechanical thrombectomy. And that is where there's a puncture usually in the groin or in the wrist and they can thread a catheter all the way up into the brain and go right to where that clot is. And if you think about kind of a plumbing analogy, if there's a big clog in your sink and it's going and it's a really long clot, sometimes Drano is not enough to get that drain back open again. And so sometimes in addition to the medication, we actually go in and surgically pull that clot out and that gets the blood flow back to the brain. And so that's another big one. And then also being in the hospital and being at a hospital that's good at taking care of stroke patients.
It's not just the medications or the surgical interventions, but also nursing care, critical care coverage that maybe a patient needs to be on a ventilator for a certain amount of time and then doing that mystery of trying to hunt down the reason for the stroke. So we mentioned already there's a lot of different things that can cause a stroke and trying to pinpoint as best we can, the cause of the stroke is going to help your doctor figure out what needs to be done and how to tailor those treatments to you and to make sure that your specific type of stroke is being targeted aggressively so that you don't have another one in the future.

Dr. Peters:
And so Dr. Charian, we want to really now focus in on the questions from our listeners 'cause it's World Stroke Day yesterday, our listeners sent in some really great questions, so I just want to thank you in advance for being here to answer them. So our first one is from Carlos from Denver. He's a stroke survivor. And his question is, "I had a minor stroke when I was just 42, and honestly it shook me. I'm constantly worried about having another one. What kinds of lifestyle changes have been shown to really help reduce the risk of a second stroke? I want to do everything I can to stay healthy."

Dr. Charian:
Okay, so it's a really good question and especially when something like this happens at a young age, I think it's unsettling and it's frightening to think about could this happen again? So thinking about positive, healthy changes to prevent a stroke from happening again. We already mentioned blood pressure is the number one modifiable risk factor for stroke. If you could have a magic wand and fix one thing to reduce your risk of stroke, it's going to be getting that blood pressure under control. So I always tell my patients know your numbers, and that means getting a home cuff, a blood pressure cuff, you can get those at any big store, drug store will sell them sometimes 25, 30 bucks and you have that and you get used to checking it regularly and keeping it at a log and you know what those numbers are doing over time.
And that way if they are running high, we really try for most patients to keep the blood pressure ideally less than 130 over 80 or ideally if you can tolerate it under 120 over 80. So when you see these readings for maybe some of the older listeners, you might remember years ago we used to say 140 over 90 and anything below that was kind of okay. And as we've gotten more and more data back, it really seems to be beneficial to be aggressive with the blood pressure and ideally keep that in a healthier range like in the 1-teens ideally.
And so if you're noticing on your home monitor, and the blood pressure can change over time, it can creep up with aging, but also it changes in your lifestyle, your diet, how much salt you're eating in your food, and if you're seeing it trend up, it's really important to stay on top of that, have a good relationship with your primary care doctor and your neurologist so that if you have to make changes to the dosage or number of medications that you need to be on, you make those immediately and you keep that blood pressure in a healthy range.
So that is probably the number one thing is the blood pressure. Other things we mentioned before, diabetes and high cholesterol, heart conditions, particularly atrial fibrillation, which is an arrhythmia that has an increased risk associated with it and you have to be on a different and stronger anti-coagulant kind of medication as opposed to maybe aspirin or Plavix. Instead you'd be on a blood thinner like Eliquis or the older meds like warfarin. Those are all big components. And then lifestyle factors. So a lot of these vascular risk factors, blood pressure, cholesterol, diabetes, are all rooted in lifestyle and particularly this Westernized American style diet where there's a lot of processed foods, a lot of salty foods and fast food, convenient food, things like that are just loaded up with salt and saturated fat, trans fat and simple carbohydrates where your blood sugar spikes up and then it drops down really fast and it makes you feel hungry again.
So shifting away from that kind of typical western diet to a healthier more Mediterranean style diet or here at Rush we developed something called the mind diet, which is a Mediterranean dash diet, so kind of low salt, Mediterranean foods. And then this emphasis on superfoods like dark leafy green vegetables, berries which are really high in antioxidants, olive oil, fish, and then mostly water to drink, not the sugary beverages and really eliminating or minimizing alcohol. And sorry, the other one, the big one is physical activity, can't go on without physical activity, probably 30 minutes a day, so up to 150 minutes a week or 75 minutes of rigorous activity. So just building that into your daily routine of getting some aerobic activity.
The strength training is really important too, at least a couple of times a week of doing that to maintain your muscle mass, which can help with your metabolic health, but it really is that aerobic exercise, walking, running, biking, whatever it's that you like to do, making sure that you're about doing that and that's going to help with a blood pressure and a host of other things for decreasing risk. And then sleep is another big one. So getting high quality restorative sleep and there is this link between sleep apnea and stroke risk. And so if you have sleep apnea and you don't know you're actually having a higher risk of stroke. So identifying sleep apnea and getting that treated can also lower your risk of stroke.

Dr. Peters:
I was just going to mention, as you were mentioning all those great foods, I started to get really hungry. That mind diet, you can have really good, healthy, delicious food that can fuel ability to exercise really well and then also turn around and get a good night's sleep. So I think those are all great advice. So our next question is from Alina from Austin. She's a concerned sibling and her question is, "My little brother had a stroke at just 29 and we are all still trying to wrap our heads around it, especially since he didn't have any obvious risk factors that I know of at least. How common are strokes in younger adults and is it genetic? Should I be worried about having one too?"

Dr. Charian:
The big story for stroke over the last 10, 15 years has been a really positive story and a win. We've got these interventions that we can do to treat strokes, and so overall we're seeing people's more likely to survive their strokes, more likely to go back to having a good quality of life. But the one concerning area is that the rate for stroke in the young, and we define that as under 55 as being young or atypical to have a stroke, that has been going up over years and when you compare maybe over the last 10 to 15 years, seen an increase of almost 15% in that stroke in the young category. And so that is concerning because with the disability that can come with stroke and all of the challenges, it really is something that is concerning. And so what is driving that? And the first thing, first and foremost really is these traditional risk factors like high blood pressure, obesity, diabetes and high cholesterol are actually increasing in younger populations.
And so when you talk to our pediatrician colleagues, they'll tell you that the rates of type two diabetes even in children and adolescents has gone up quite a bit. And so you're seeing a lot of these unhealthy lifestyles as we've moved to a more sedentary culture, a lot more processed easily to access foods, that these traditional risk factors are setting in earlier in life. And the sooner that you develop diabetes, high blood pressure, high cholesterol, the more wear and tear that's going to take on your cerebrovascular system and the more increased risk of stroke that you're going to have. Now there are other things in addition to the traditional risk factors that can be going on as well, including some recreational drug use. So things like cigarette smoking, tobacco use, marijuana has become, in some studies we've read almost more popular than alcohol in areas of our country and has really been understudied.
It's been banned at the federal level. And so we don't have as much high quality data as we do for other recreational substances like alcohol or like tobacco, and yet the use is really proliferating. And then just those environmental factors as well, the kind of physical activity levels. There are some atypical causes for stroke in young individuals as well, that are different than for older people. So when we think about younger women for example, there are a lot of hormonal changes. So peripartum pregnancy, some of the hormonal birth control options have increased risk of thrombosis, which is clotting, and risk of stroke.
And so stroke in the young, when you look at women in particular, there's a whole different set of factors that you have to evaluate related to sex specific risk factors for women and then other things like dissection. So that typically is a trauma. So having a tear on the lining of the blood vessel that can be a cause of stroke in young individuals. And then atypical causes of stroke, autoimmune diseases, things like vasculitis and other conditions that are a little bit less likely. Whenever you see a young person have a stroke, you want to keep sort of a broad open mind and think about is there something we're missing, is there something else that we should be testing for to make sure that we're not missing something.

Dr. Peters:
Well, thank you, Lena, for that question and we'll move on to the next question from Angela from Seattle who is another stroke survivor. And she writes, "Ever since my stroke I've been dealing with this overwhelming fatigue that just doesn't seem to go away. It's frustrating and it makes recovery feel even harder. Is this kind of post-stroke exhaustion normal and what do people usually do to manage it? There's not enough coffee in the world."

Dr. Charian:
Well, I can definitely sympathize with feeling like there's not enough coffee in the world, but for our stroke survivors, this is a really common complaint. And I think honest, I'm glad she asked this question because I think post-stroke fatigue is overlooked and it's such a common complaint that patients have, probably almost 50% of patients have some degree of this. And I hear this all the time in the clinic, and this is even for people who've had a really good outcome. Maybe there's no paralysis, they don't have any aphasia, they have pretty good physical recovery, but they'll tell me, "Boy, I'm still just dragging. I don't feel like myself. I was never somebody who had to take a nap and now every afternoon I've got to lie down and take a nap for an hour. That was never me before." And so it is really common.
I think it's reassuring in that some patients over time feel that fatigue start to lift particularly six months to a year after a stroke for a significant number of patients, they eventually do feel like they get back to their usual self. And then for others it does linger longer and can be a really frustrating symptom. One thing that I would recommend if you are a stroke survivor and are struggling with fatigue is to look at a couple other things that might be fixable. So one of them, we mentioned earlier, sleep disturbances and how common sleep apnea is. Now, sleep apnea is a risk factor for having a stroke, but having a stroke also increases your risk of developing sleep disturbances, like, sleep apnea. So if you're feeling really fatigued through the day, if you got a long amount of sleep and you wake up and you don't feel refreshed or you're waking up frequently throughout the night or you're having trouble going to sleep, you have insomnia, those are all reasons to go see a sleep specialist, and some of that fatigue could actually be rooted in not getting good quality sleep.
And there were treatments for sleep disturbances, whether it's CPAP for sleep apnea or other things. And so you want to address the sleep component of it. The other big thing that can overlap with feeling fatigued and feeling down is depression and anxiety. And post-stroke mood disorders, post-stroke mental health challenges are extremely common. Probably 30 to 50% of patients deal with some degree of this after a stroke. And those feelings of depression in particular can really kind of overlay with feelings of fatigue and feeling like you're dragging and you're down. So if there is any kind of a mood component, getting depression treated can help that sense of fatigue, not just make you feel less depressed but can also sometimes improve your energy levels.
Other things to think about are medication side effects. So some of the medicines that you're on, maybe if there's spasticity and you have to be on something like Baclofen or you have nerve pain and you're on gabapentin, beta blockers are pretty common, it's a anti-hypertensive, so blood pressure medication can have fatigue associated with it. So look at the medicines and kind of talk through with your doctor and see maybe there's a similar medicine that doesn't have those side effects and can help with the fatigue as well. The other big thing is deconditioning. So especially if you had a prolonged hospital stay and were maybe in the ICU for a long amount of time or were bed bound, just losing that muscle mass and not being as physically strong as you were before your stroke, it can be a vicious cycle 'cause if you feel too fatigued to exercise, then you start to lose your conditioning.
And sometimes if you just sort of force yourself to get that exercise into your day, weirdly you end up feeling more energetic after you exercise. So it's just sometimes getting over that mental barrier to get out there and get moving. And sometimes that can actually help the fatigue lift as well. And then finally, just all the inflammation and your body having to heal and all the changes that come with a stroke, some of that fatigue is natural and it's part of your body healing after a stroke. And so if you do feel tired and that you need to rest some of that allowing yourself to rest may be your body repairing itself and healing after the stroke, especially early on after a stroke as well.
So sometimes it may not be a forever feeling, but it may just be something that you got to pace yourself and maybe you were a real go, go go person before the stroke and now you think, "Okay, rather than doing these five chores back to back to back, I'm going to do two of them and then I'm going to take a rest and then I'm going to go back and do another one." And you just kind of map out your day a little bit differently than maybe you did before your stroke, but you're still doing everything you need to do, but you're just pacing yourself a little bit different.

Dr. Peters:
Eventually you'll get back to another level of function. But I think that's really important to remind people to pace themselves and to give themselves also a little bit of grace after having, you know, it's also traumatic having a stroke and everything that comes with it. But what's great is we're getting wonderful questions from stroke survivors and that's what we want on World Stroke Day or the day afterwards, stroke day. So I have another question from another stroke survivor. It sort of goes into sort of what you just touched on. This is from Tom from San Diego. He said, "It's been two years since my stroke and while I've made progress physically, I still feel like people treat me like I'm not quite the same person. They're tiptoeing around me. How do other stroke survivors cope with the social and emotional challenges that come with recovery?" So sort of touching in on some of those mood changes that you mentioned before.

Dr. Charian:
Yeah, absolutely. So some of that, first look within and see is this a perception issue and is it maybe that you are feeling anxious, particularly for my patients who have aphasia, even if it's just mild, it can be a little bit stressful to be back in a social environment. And even if you don't have language difficulty, just that processing speed of kind of following and being at a party or being in a really loud environment where a lot of different people are talking all at once can be a little bit tricky. The other thing is that the people around you, friends and family, the people who are close to you hopefully have a really good sense of what you've been through and have been there with you every step of the way. And you probably don't need to explain things for them, 'cause they were in it with you.
But for more acquaintances or maybe you go back to work after something and the people that you don't know as well, I think that can be unsettling and they may be nervous, they may not know what your new normal is and they may be really well-intentioned and wanting to help you and you think, "You're babying me. Stop it." And so I think open communication is really important and just being proactive and kind of telling people like, "No, I'm okay. I don't need you to change things." Or maybe you do and you say, "Look, I do need a little bit more time, but I can still do this and I still want you to treat me the same way you did before."
And you can take some ownership of that as well. And I think these relationships sometimes coming back from a major illness, stroke or anything else can be a little bit difficult to navigate. And I think the take-home point is people by and large want you to succeed and they're excited to see you back, excited to see that you've recovered from your stroke and they want to help. And so I think just be open and I think being honest with where you are in your recovery journey can be a good first step.

Dr. Peters:
I agree with you completely and it is challenging 'cause I often see, you know, I treat patients with brain cancer and they'll have a recovery period and sometimes people after surgery want to put them in a bubble a little bit and they want to get out beyond the bubble. And so I agree with you, communication is just critically important.

Dr. Charian:
The other thing I'll put out there is, find other people who are stroke survivors. So our group at Rush, we've got a great stroke survivor group and we've got some wonderful people who donate their time. They'll come back into the hospital, they talk to patients and families that have had an acute stroke or they go out to community events and then they just bond with each other. I mean, nobody understands what it's like to go through this better than another stroke survivor. So sometimes those relationships can be really nice to build. And then you can also be giving back to your community and giving back to somebody else who's maybe on day one of this stroke recovery journey and you're a year or so out and you really have that nice perspective and I think can be a source of hope to other people who are stroke survivors as well.

Dr. Peters:
Absolutely. So our next question has a little bit about those relationships. It's from a caregiver who's a full-time caregiver. It's Mark from Wisconsin, and he writes, "Since my wife's stroke, her mobility has been pretty limited and it's changed a lot of how we live day-to-day. As her full-time caregiver, I'm trying to figure out what kinds of adaptive devices or home modifications could make things easier for both of us. Any suggestions?"

Dr. Charian:
Yeah, really, really important, both for safety, but also just for getting back to a good quality of life after stroke. So I would really put in a plug for our colleagues in physical and rehabilitative medicine, PMNR. They can be a really wonderful resource in addition to physical and occupational therapists for what the latest tech is, what the latest devices are, and really looking around your home. Some of this stuff is not real fancy or real expensive to do. Really simple things like looking at area rugs, small furniture like step stools, clutter, things where you're going to kind of clean up the possibility of tripping over things, particularly in high traffic areas or places you might walk at night, particularly going from the bed to the bathroom.
You don't want anything on the floor that could cause you to have a fall. And then in terms of more to the question of what specific adaptive devices or modifications, things like putting in if you're not able to be walking at all ramps into the home, widening doorways, if it's someone who needs a wheelchair or perhaps a walker, things like grab bars, especially in the shower and a toilet that's a little bit highly or off the ground so that you're not having to go from such a distance up and down, getting on and off, going to the bathroom. And then in terms of physical activity as well, patients who used to enjoy to do things recreationally, there can be adaptive devices that allow you to continue to do what you like to do. I have a patient that was a big biker before her stroke and she has a recumbent bike that she's now on, so she's kind of seated and a little bit lower to the ground.
She actually does pretty well biking, but God forbid if she took a tumble, she's not going to fall very far on a recumbent bike as opposed to a regular bike. And so other things like that, you can kind of still do the things you like to do, but you might just have to change a little bit the equipment that you use. I have another patient who's back to driving, but they have a knob on their steering wheel of the car, and so they can use that to kind of help turn a little bit more easily or more quickly than having to use two hands on a regular steering wheel. And so there's a lot of different modifications that we can make, chopping the kind of knives or some really cool kind of rocker type of knives that are easier than using that kind of sawing back and forth motion. So just all sorts of gadgets. I would recommend going, again, PMNR is a great resource, but going on some of the websites and just checking out American Heart Association, et cetera, and getting connected to some of those options. Also,

Dr. Peters:
This is where I think also those caregivers can also form a community and give each other tips and tricks. And you can also check out our podcast. We actually got to interview Will Shorts. He was the editor for the New York Times Crossword Puzzles and all the puzzles. He had a stroke and he and his partner actually booby-trapped their entire home with gadgets and he was really working at rehab, so I was really inspired by him. But Dr. Charian, we really appreciate you today, appreciate it to you also yesterday for World Stroke Day. Thank you so much for answering our listeners questions and thank you to our listeners for submitting all these great questions for us to answer today.

Dr. Charian:
Thanks so much for having me and loved hearing all the questions from stroke survivors, so thanks again.

Dr. Correa:
Thank you again for joining us today on the Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain & Life magazine for free at brainandlife.org.

Dr. Peters:
Also for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org and leave us a message at 612-928-6206.

Dr. Correa:
You can also find that information in our show notes and you can follow Katy and me and the Brain & Life magazine on many of your preferred social media channels. We're your hosts, Dr. Daniel Correa, connecting with you from New York City and online @neurodrcorrea.

Dr. Peters:
And Dr. Katy Peters joining you from Durham, North Carolina and online at Katy Peters MD PhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

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Understanding Stroke with Dr. Laurel Cherian

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