Stroke treatment has come a long way

The bad news: People having a stroke may not recognize it as such, sometimes mistaking it for a pinched nerve, a migraine, or a tingling sensation that will go away.

The good news: Fairfield County hospitals offer the latest treatment techniques that open the window of opportunity for successful treatment and patient recovery.

Joshua Marcus, a neurosurgeon, will discuss both aspects of stroke and many others in between at the latest offering of the Health Literary Series presented by Wilton Library and Western Connecticut Health Network. The Bulletin is the media sponsor. The program will take place Wednesday, Oct. 24, 7 p.m., at the library. It is free, but registration is suggested by visiting or calling 203-762-6334.

Each year, about 800,000 people in the U.S. suffer a stroke. They can range from their teens to the elderly.

“I treated two strokes recently for people in their 20s and teens,” Marcus told The Bulletin while discussing his upcoming visit to Wilton.

Historically, he said, people are unfamiliar with symptoms than can and cannot be related to a stroke. “Chest pain is probably the heart,” he said, “but because a stroke doesn’t really hurt, the symptoms are a little less recognized.”

The major symptom is a person’s inability to speak or move a side of their body, but there are subtle symptoms as well, he said, such as a mild weakness in the arm. “Symptoms that go away may be a precursor of a major stroke,” he said. “If we treat those, we may prevent a major stroke.”

There are two types of stroke: ischemic, which is caused by a blood clot, and hemorrhagic, caused by a rupture in a blood vessel in the brain. The vast majority — 87% — of strokes are the ischemic type.

Other information people tend to lack, Marcus said, is what and where appropriate treatment is available. A drug known as  tissue plasminogen activator (tPA) is widely available in hospital emergency rooms for ischemic stroke patients and there are many good neurologists who can treat them. The drug is given through an IV in the arm and works by dissolving the clot and improving blood flow to the brain. It must be given within three hours of a stroke’s onset, or up to four and a half hours in certain patients.

Since 2015, however, neurosurgeons have been using a procedure known as endovascular stroke treatment. It involves inserting a catheter through the groin and opening blocked vessels in the brain. It was not available until 2016 and Marcus is the only doctor in Fairfield County trained in this latest minimally invasive treatment. He and his team at Danbury Hospital and Norwalk Hospital were the first in western Connecticut to successfully use this procedure. It can expand the window of opportunity for treatment to six hours and in some cases 16 to 24 hours.

With that opportunity here, Marcus said, it is important for people to be aware of what therapies are available and where they are available. By the same token, people should give careful consideration when they go to a hospital for other treatments including cancer and general surgery. “Does it have the ability to treat all potential complications?” he said.


Things don’t need to go that far, Marcus said. “We think 80% of strokes can be prevented by things like blood pressure, smoking, obesity,” he said. “All the things that are good for your heart are good for your brain.

“There is so much information out there about how to prevent a heart attack. It’s no different for stroke. The risk factors are almost the same.”

Marcus said he is looking forward to his presentation and believes young people in particular will benefit because they don’t think about stroke as happening to them. He will also answer questions from the audience.

In addition to stroke, Marcus is a neurosurgeon who focuses on the minimally invasive treatment of brain and spine conditions, including tumors, degenerate and traumatic spine disease, trigeminal neuralgia, and other chronic pain syndromes as well as disorders of the cerebrovascular system.

He graduated summa cum laude and Phi Beta Kappa from Binghamton University. He attended New York University School of Medicine and completed his residency training in neurological surgery at New York Presbyterian/Weill Cornell Medical College. While a resident, Marcus served as chief resident and was the recipient of the Distinguished House Staff award in neurosurgery.
Following his residency, he completed a fellowship in endovascular neurosurgery/interventional neuroradiology. He has received advanced training at Memorial Sloan Kettering Cancer Center to manage brain and spinal cord tumors with modern surgical techniques and technologies as well as non-invasive stereotactic radiosurgery.