Sherry Chou

Last updated
Sherry Hsiang-Yi Chou
Alma mater McGill University
Beth Israel Deaconess Medical Center
Massachusetts General Hospital
Brigham and Women's Hospital
Known forNeurology
Critical care
Stroke
Scientific career
Institutions University of Pittsburgh
Harvard Medical School

Sherry Hsiang-Yi Chou is a Canadian neurologist and an Associate Professor of Neurology and Chief of Neurocritical Care at the Northwestern University Feinberg School of Medicine and Northwestern Medicine. She is a Fellow of the Neurocritical Care Society and the Society of Critical Care Medicine. During the COVID-19 pandemic Chou assembled a worldwide team of physicians and scientists to better understand the neurological impacts of COVID-19, forming the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID). [1] [2] The first report of this large, multicenter, multicontinent consortium found that neurological manifestations are present in 8 out of 10 adult patients hospitalized with COVID-19 and are associated with increased mortality. [3]

Contents

Early life and education

Chou studied mathematics and physics at McGill University. She remained there for her medical degree, which she completed in 2001. [4] Chou completed medical internship at Beth Israel Deaconess Medical Center and residency in Neurology followed by fellowship in stroke and neurocritical care at Massachusetts General Hospital and Brigham and Women's Hospital. [5] Chou completed a master's degree in clinical translational research at Harvard Medical School in 2009. Following completion of training Chou remained on faculty at Brigham and Women's Hospital, where Chou worked on numerous large clinical trials such as the Antihypertensive Treatment of Acute Cerebral Hemorrhage-II (ATACH-II) research protocol, which looked to identify the therapeutic benefit of intensive blood pressure treatment in intracerebral haemorrhage patients. [6] She worked at Brigham for several years, holding a simultaneous faculty position at the Harvard Medical School.

Research and career

Chou was appointed to the University of Pittsburgh in 2014. Her research and practise looks to improve the treatment of critically ill patients who suffer from haemorrhagic brain injury. Chou has a particular focus on subarachnoid haemorrhage (SAH) and the identification of novel biomarkers. She studies how the inflammation that occurs after SAH can result in secondary brain injury, and how this impacts recovery. To do this, Chou monitors microRNA biomarkers of systemic inflammation. [7] She created a biobank of samples collected over the course of patients' time in hospital. This data allowed Chou to identify a specific inflammation biomarker that is only detectable in the early days of brain injury. [4]

During the COVID-19 pandemic it emerged that in certain cases, the viral infection resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause a rare type of encephalopathy. These observations were first observed in Wuhan, and subsequently across Europe and the United States. [8] The overreaction of the immune system in response to SARS-CoV-2 infection triggers a cytokine storm, whereby immune cells and cytokines are excessively produced. [9] Cytokine overproduction can cause small haemorrhages in the brain. [9] Whilst the neurological symptoms related to COVID-19 are rare, Chou argued that physicians needed to crowdsource their observations to provide better care. [10] [11] COVID-19 may its way upward to the brain through the nose and olfactory bulb, which may explain the anosmia. [12] The Centers for Disease Control and Prevention (CDC) added "new confusion or inability to arouse" to their COVID–19 emergency warning signs, which means that people who show these symptoms must seek medical attention immediately. [13] Through her work with the Neurocritical Care Society, Chou has since established a world-wide consortium of researchers to track the prevalence of neurological complications in hospitalised COVID-19 patients. [14]

Awards and honours

Selected publications

Chou serves on editorial board of the journal Neurocritical Care on Call. [20]

Related Research Articles

<span class="mw-page-title-main">Head injury</span> Serious trauma to the cranium

A head injury is any injury that results in trauma to the skull or brain. The terms traumatic brain injury and head injury are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of injuries, there are many causes—including accidents, falls, physical assault, or traffic accidents—that can cause head injuries.

<span class="mw-page-title-main">Intracranial aneurysm</span> Cerebrovascular disorder

An intracranial aneurysm, also known as a cerebral aneurysm, is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.

<span class="mw-page-title-main">Cerebrovascular disease</span> Condition that affects the arteries that supply the brain

Cerebrovascular disease includes a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often damaged or deformed in these disorders. The most common presentation of cerebrovascular disease is an ischemic stroke or mini-stroke and sometimes a hemorrhagic stroke. Hypertension is the most important contributing risk factor for stroke and cerebrovascular diseases as it can change the structure of blood vessels and result in atherosclerosis. Atherosclerosis narrows blood vessels in the brain, resulting in decreased cerebral perfusion. Other risk factors that contribute to stroke include smoking and diabetes. Narrowed cerebral arteries can lead to ischemic stroke, but continually elevated blood pressure can also cause tearing of vessels, leading to a hemorrhagic stroke.

<span class="mw-page-title-main">Cerebral edema</span> Excess accumulation of fluid (edema) in the intracellular or extracellular spaces of the brain

Cerebral edema is excess accumulation of fluid (edema) in the intracellular or extracellular spaces of the brain. This typically causes impaired nerve function, increased pressure within the skull, and can eventually lead to direct compression of brain tissue and blood vessels. Symptoms vary based on the location and extent of edema and generally include headaches, nausea, vomiting, seizures, drowsiness, visual disturbances, dizziness, and in severe cases, death.

<span class="mw-page-title-main">Stroke</span> Death of a region of brain cells due to poor blood flow

Stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functioning properly.

<span class="mw-page-title-main">Subarachnoid hemorrhage</span> Bleeding into the subarachnoid space

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain. Symptoms may include a severe headache of rapid onset, vomiting, decreased level of consciousness, fever, weakness, numbness, and sometimes seizures. Neck stiffness or neck pain are also relatively common. In about a quarter of people a small bleed with resolving symptoms occurs within a month of a larger bleed.

A thunderclap headache is a headache that is severe and has a sudden onset. It is defined as a severe headache that takes seconds to minutes to reach maximum intensity. Although approximately 75% are attributed to "primary" headaches—headache disorder, non-specific headache, idiopathic thunderclap headache, or uncertain headache disorder—the remainder are secondary to other causes, which can include some extremely dangerous acute conditions, as well as infections and other conditions. Usually, further investigations are performed to identify the underlying cause.

<span class="mw-page-title-main">Intracerebral hemorrhage</span> Type of intracranial bleeding that occurs within the brain tissue itself

Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and haemorrhagic stroke, is a sudden bleeding into the tissues of the brain, into its ventricles, or into both. An ICH is one kind of bleeding within the skull and one kind of stroke. Symptoms can include headache, one-sided weakness, numbness, tingling, or paralysis, speech problems, vision or hearing problems, memory loss, attention problems, coordination problems, balance problems, dizziness or lightheadedness or vertigo, nausea/vomiting, seizures, decreased level of consciousness or total loss of consciousness, and neck stiffness. Often, symptoms get worse over time. Fever is also common.

<span class="mw-page-title-main">Brain ischemia</span> Medical condition

Brain ischemia is a condition in which there is insufficient bloodflow to the brain to meet metabolic demand. This leads to poor oxygen supply or cerebral hypoxia and thus leads to the death of brain tissue or cerebral infarction/ischemic stroke. It is a sub-type of stroke along with subarachnoid hemorrhage and intracerebral hemorrhage.

<span class="mw-page-title-main">Vertebral artery dissection</span> Tear of the inner lining of the vertebral artery

Vertebral artery dissection (VAD) is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke symptoms such as difficulty speaking, impaired coordination, and visual loss. It is usually diagnosed with a contrast-enhanced CT or MRI scan.

<span class="mw-page-title-main">Intraventricular hemorrhage</span> Medical condition

Intraventricular hemorrhage (IVH), also known as intraventricular bleeding, is a bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. It can result from physical trauma or from hemorrhagic stroke.

<span class="mw-page-title-main">Cerebral venous sinus thrombosis</span> Presence of a blood clot in the dural venous sinuses or cerebral veins

Cerebral venous sinus thrombosis (CVST), cerebral venous and sinus thrombosis or cerebral venous thrombosis (CVT), is the presence of a blood clot in the dural venous sinuses, the cerebral veins, or both. Symptoms may include severe headache, visual symptoms, any of the symptoms of stroke such as weakness of the face and limbs on one side of the body, and seizures, which occur in around 40% of patients.

<span class="mw-page-title-main">Neurointensive care</span> Branch of medicine that deals with life-threatening diseases of the nervous system

Neurocritical care is a medical field that treats life-threatening diseases of the nervous system and identifies, prevents, and treats secondary brain injury.

<span class="mw-page-title-main">External ventricular drain</span> Medical device

An external ventricular drain (EVD), also known as a ventriculostomy or extraventricular drain, is a device used in neurosurgery to treat hydrocephalus and relieve elevated intracranial pressure when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed. An EVD is a flexible plastic catheter placed by a neurosurgeon or neurointensivist and managed by intensive care unit (ICU) physicians and nurses. The purpose of external ventricular drainage is to divert fluid from the ventricles of the brain and allow for monitoring of intracranial pressure. An EVD must be placed in a center with full neurosurgical capabilities, because immediate neurosurgical intervention can be needed if a complication of EVD placement, such as bleeding, is encountered.

<span class="mw-page-title-main">Midline shift</span> Sideways displacement of the brain

Midline shift is a shift of the brain past its center line. The sign may be evident on neuroimaging such as CT scanning. The sign is considered ominous because it is commonly associated with a distortion of the brain stem that can cause serious dysfunction evidenced by abnormal posturing and failure of the pupils to constrict in response to light. Midline shift is often associated with high intracranial pressure (ICP), which can be deadly. In fact, midline shift is a measure of ICP; presence of the former is an indication of the latter. Presence of midline shift is an indication for neurosurgeons to take measures to monitor and control ICP. Immediate surgery may be indicated when there is a midline shift of over 5 mm. The sign can be caused by conditions including traumatic brain injury, stroke, hematoma, or birth deformity that leads to a raised intracranial pressure.

The Neurocritical Care Society (NCS) is an international, multidisciplinary medical society first established in 2002. The Society is dedicated to improving the care and outcomes of patients with life-threatening neurologic illnesses in the intensive care unit. Common illnesses requiring neurocritical care include ischemic stroke, subarachnoid hemorrhage, intracranial hemorrhage, traumatic brain and spinal cord injury, coma, and status epilepticus. Its members are health professionals providing care to critically ill and injured patients. The Society supports research and education, and advocates on issues related to neurointensive care, neurocritical care, and general critical care.

Clinicians routinely check the pupils of critically injured and ill patients to monitor neurological status. However, manual pupil measurements have been shown to be subjective, inaccurate, and not repeatable or consistent. Automated assessment of the pupillary light reflex has emerged as an objective means of measuring pupillary reactivity across a range of neurological diseases, including stroke, traumatic brain injury and edema, tumoral herniation syndromes, and sports or war injuries. Automated pupillometers are used to assess an array of objective pupillary variables including size, constriction velocity, latency, and dilation velocity, which are normalized and standardized to compute an indexed score such as the Neurological Pupil index (NPi).

<span class="mw-page-title-main">Impact of the COVID-19 pandemic on neurological, psychological and other mental health outcomes</span> Effects of the COVID-19 pandemic and associated lockdowns on mental health

There is increasing evidence suggesting that COVID-19 causes both acute and chronic neurologicalor psychological symptoms. Caregivers of COVID-19 patients also show a higher than average prevalence of mental health concerns. These symptoms result from multiple different factors.

Stephan A. Mayer is an American neurologist and critical care physician who currently serves as Director of Neurocritical Care and Emergency Neurology Services for the Westchester Medical Center Health System. Mayer is most noted for his research in subarachnoid and intracerebral hemorrhage, acute ischemic stroke, cardiac arrest, coma, status epilepticus, brain multimodality monitoring, therapeutic temperature modulation, and outcomes after severe brain injury. He has gained media attention for popularizing the concept that physicians have historically underestimated the brain’s resilience and capacity for recovery. He has authored over 400 original research publications, 200 chapters and review articles, and 370 abstracts.

Spinal cord stroke is a rare type of stroke with compromised blood flow to any region of spinal cord owing to occlusion or bleeding, leading to irreversible neuronal death. It can be classified into two types, ischaemia and haemorrhage, in which the former accounts for 86% of all cases, a pattern similar to cerebral stroke. The disease is either arisen spontaneously from aortic illnesses or postoperatively. It deprives patients of motor function or sensory function, and sometimes both. Infarction usually occurs in regions perfused by anterior spinal artery, which spans the anterior two-thirds of spinal cord. Preventions of the disease include decreasing the risk factors and maintaining enough spinal cord perfusion pressure during and after the operation. The process of diagnosing the ischemic and hemorrhagic spinal cord stroke includes applying different MRI protocols and CT scan. Treatments for spinal cord stroke are mainly determined by the symptoms and the causes of the disease. For example, antiplatelet and corticosteroids might be used to reduce the risk of blood clots in ischaemic spinal stroke patients, while rapid surgical decompression is applied to minimize neurological injuries in haemorrhagic spinal stroke patients instead. Patients may spend years for rehabilitation after the spinal cord stroke.

References

  1. ↑ Frontera, Jennifer; Mainali, Shraddha; Fink, Ericka L.; Robertson, Courtney L.; Schober, Michelle; Ziai, Wendy; Menon, David; Kochanek, Patrick M.; Suarez, Jose I.; Helbok, Raimund (August 2020). "Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID): Study Design and Rationale". Neurocritical Care. 33 (1): 25–34. doi:10.1007/s12028-020-00995-3. ISSN   1541-6933. PMC   7243953 . PMID   32445105.
  2. ↑ McNett, Molly; Fink, Ericka L.; Schober, Michelle; Mainali, Shraddha; Helbok, Raimund; Robertson, Courtney L.; Mejia-Mantilla, Jorge; Kurtz, Pedro; Righy, Cássia; Roa, Juan D.; Villamizar-Rosales, Carlos (December 2020). "The Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID): Development of Case Report Forms for Global Use". Neurocritical Care. 33 (3): 793–828. doi:10.1007/s12028-020-01100-4. ISSN   1541-6933. PMC   7500499 . PMID   32948987.
  3. ↑ Chou, Sherry H.-Y.; Beghi, Ettore; Helbok, Raimund; Moro, Elena; Sampson, Joshua; Altamirano, Valeria; Mainali, Shraddha; Bassetti, Claudio; Suarez, Jose I.; McNett, Molly (2021-05-11). "Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19—A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium". JAMA Network Open. 4 (5): e2112131. doi: 10.1001/jamanetworkopen.2021.12131 . ISSN   2574-3805. PMC   8114143 . PMID   33974053.
  4. 1 2 3 "Bench AND bedside: winning combination for Sherry Chou : Medicine Focus" . Retrieved 2020-04-21.
  5. ↑ "Chou, Sherry | Department of Critical Care Medicine". ccm.pitt.edu. Retrieved 2020-04-21.
  6. ↑ "Critical Care Neurology Research - Brigham and Women's Hospital". www.brighamandwomens.org. Retrieved 2020-04-21.
  7. ↑ "INCLINE Grant for Neurocritical Care Research Awarded to Sherry Chou, MD, MMSc | Department of Critical Care Medicine". ccm.pitt.edu. Retrieved 2020-04-21.
  8. ↑ Rabin, Roni Caryn (2020-04-01). "Some Coronavirus Patients Show Signs of Brain Ailments". The New York Times. ISSN   0362-4331 . Retrieved 2020-04-21.
  9. 1 2 "In Some Cases, COVID-19 May Harm the Brain". WebMD. Retrieved 2020-04-21.
  10. ↑ Higgs, Robert (2020-04-07). "Medical experts suspect COVID-19 coronavirus capable of harming the brain". cleveland. Retrieved 2020-04-22.
  11. ↑ "Education and Research". www.aan.com. Retrieved 2020-04-22.
  12. ↑ Wadman, Meredith; Couzin-Frankel, Jennifer; Kaiser, Jocelyn; Matacic, Catherine (2020-04-17). "How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes". AAAS. Retrieved 2020-04-21.
  13. ↑ "Coronavirus Disease 2019 (COVID-19) – Symptoms". Centers for Disease Control and Prevention. 2020-04-17. Retrieved 2020-04-21.
  14. ↑ "Doctors investigate rare COVID-19 symptoms in effort to move quickly from anecdotes to science". CBC.ca. 8 April 2020. Retrieved 17 October 2021.
  15. ↑ "Neurocritical Care Society Inductees". www.neurocriticalcare.org. Retrieved 2020-04-21.
  16. ↑ Chou, Sherry H.-Y.; Feske, Steven K.; Atherton, Juli; Konigsberg, Rachael G.; De Jager, Philip L.; Du, Rose; Ogilvy, Christopher S.; Lo, Eng H.; Ning, MingMing (2012-10-01). "Early Elevation of Serum Tumor Necrosis Factor-α Is Associated With Poor Outcome in Subarachnoid Hemorrhage". Journal of Investigative Medicine. 60 (7): 1054–1058. doi:10.2310/jim.0b013e3182686932. ISSN   1081-5589. PMC   3740211 . PMID   22918199.
  17. ↑ Chou, Sherry H.-Y.; Lan, Jing; Esposito, Elga; Ning, MingMing; Balaj, Leonora; Ji, Xunming; Lo, Eng H.; Hayakawa, Kazuhide (August 2017). "Extracellular Mitochondria in Cerebrospinal Fluid and Neurological Recovery After Subarachnoid Hemorrhage". Stroke. 48 (8): 2231–2237. doi:10.1161/strokeaha.117.017758. ISSN   0039-2499. PMC   5526718 . PMID   28663512.
  18. ↑ Berkowitz, A.L.; Westover, B.; Bianchi, M.T.; Chou, S.H. (2015-03-12). "Aspirin for secondary prevention after stroke of unknown etiology in resource-limited settings: a decision analysis". Annals of Global Health. 81 (1): 87. doi: 10.1016/j.aogh.2015.02.702 . ISSN   2214-9996.
  19. ↑ Berkowitz, A. L.; Westover, M. B.; Bianchi, M. T.; Chou, S. H.- Y. (2014-07-23). "Aspirin for acute stroke of unknown etiology in resource-limited settings: A decision analysis". Neurology. 83 (9): 787–793. doi:10.1212/wnl.0000000000000730. ISSN   0028-3878. PMC   4155044 . PMID   25056582.
  20. ↑ "Editorial Board - NCC On Call". oncall.neurocriticalcare.org. Retrieved 2020-04-21.
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