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Dr. Gregory Rozansky awarded the Daniel M. Soref Fellowship for Clinical Neuroscience

Gregory Rozansky, MD

Dr. Gregory Rozansky, a fellow in Neuro-Critical Care, was awarded the Daniel M. Soref Fellowship for Clinical Neuroscience at the Medical College of Wisconsin for the 2018/2019 academic year in a competitive process. Clinical fellows from throughout Neurosciences are invited to submit research projects for consideration. Those projects are then judged by a group of researchers and leaders in Neurosciences. Dr. Rozansky’s research on risk of pulmonary edema in aneurysmal subarachnoid hemorrhage patients is being generously supported by the Daniel M. Soref Trust. Dr. Pramod Gupta, a neuro-intensivist and also program Director of the Neuro-Critical Care fellowship is serving as Dr. Rozansky’s mentor.

Dr. Rozansky’s Proposal

Multiple studies have described cardiac complications such as EKG changes [1], troponin release[2], regional wall motion abnormality[3], left ventricular systolic dysfunction [4] and transient apical hypokinesis[5] in patients with aneurysmal subarachnoid hemorrhage. Recently, the prevalence of new-onset left ventricular diastolic dysfunction has been established [6]. Such sequelae, affecting cardiac function, in patients with primary CNS injuries are referred to collectively as “neurogenic cardiac stunning,” “neurogenic stress cardiomyopathy,” and “neurogenic stunned myocardium” [7]. The incidence of such complications in patients with aneurysmal subarachnoid hemorrhage varies significantly as a result of an imprecise definition of secondary cardiac impairments.

One well known complication from new onset cardiac dysfunction is pulmonary edema resulting in respiratory failure and prolonged intubation. This is especially true for aneurysmal subarachnoid hemorrhage patients who are maintained at a euvolemic status in an attempt to improve cerebral perfusion and prevent delayed cerebral ischemia. Rather than periodically assess patients for cardiac dysfunction, which would be technically difficult, I propose that daily bedside assessment for pulmonary edema would allow for a more precise identification of populations who are at a higher risk for pulmonary edema. A wide spectrum of patients with baseline comorbidities, severity of SAH at presentation and clinical course are treated regularly in the Neuro ICU for aneurysmal subarachnoid hemorrhage. I seek a better predictive model that may be able to identify those patients where fluid management should be performed more judiciously based on a thorough assessment of the intravascular fluid status.

He proposes multi-step project consisting of data-collection followed by a retrospective analysis, to identify statistically significant correlations that can be used as a predictive model for patients who are at risk to develop pulmonary edema. I will further define criteria for patient enrollment (likely high-grade aneurysmal subarachnoid hemorrhage). Once the patient is enrolled, I personally will perform daily bedside pulmonary ultrasonography to identify patients who are developing pulmonary edema. This is a well-established modality to assess for pulmonary edema requiring minimal training [8]. Following data collection, we will attempt to identify premorbid risk factors for pulmonary edema. This can significantly affect how the Neuro Intensivist assesses fluid status and maintains euvolemia in this patient population.