On a warm day in July 2005, Frank Garcea’s soccer playing days came to an abrupt end when he suffered what could have been a deadly stroke during a practice with his teammates. Instead, the events of that day and his subsequent treatment – which serve as the basis for a review published in the New England Journal of Medicine (NEJM) – set him on a career path that would ultimately lead to a Ph.D. studying how the brain recovers from injury.
Garcea, who was about to begin his senior year at the Aquinas Institute in Rochester, was in the middle of a training session when he started experiencing a pounding headache. He first suspected he might just be dehydrated on that hot summer day, but soon after his limbs began to tingle and grow numb, his eyes became sensitive to the bright sunlight, and he had difficulty walking. Very quickly it became obvious that something was wrong and someone called 911.
Garcea eventually ended up at Strong Memorial Hospital and was diagnosed with a subarachnoid hemorrhage. He would undergo surgery the next morning under the clinical care of UR Medicine neurosurgeon Edward Vates, M.D., Ph.D.
Subarachnoid hemorrhages account for approximately 5-10 percent of all strokes in the U.S. These occur when a blood vessel in the brain bursts causing bleeding. If not treated immediately, these strokes can cause major disability and, in many cases, death.
“When an aneurysm ruptures, it is an intracranial catastrophe,” said Vates, a co-author of the NEJM article. “In 25 to 50 percent of cases, these strokes result in death, and this estimate does not fully account for patients who die before receiving medical attention.”
Vates uses Garcea’s experience as jumping off point to describe the decision-making process required to diagnose and identify treatment options for subarachnoid hemorrhages.
The first symptom of these types of stroke is severe and sudden headache that is often described as a “thunderclap.” Garcea recalled the headache that heralded his stroke was unlike anything he had every experienced.
Certain factors can increase risk for subarachnoid hemorrhages, such as a family history of these strokes, smoking, high blood pressure, alcohol abuse, and kidney disease. However, as was the case with Garcea, these strokes can also occur without warning in healthy individuals.
As with other forms of stroke, immediate medical attention is essential. Once confirmed by a CT scan or angiogram, the aneurysm must be treated to eliminate the risk of further bleeding and likely death. Surgeons can either perform a craniotomy to find the aneurysm and clip it or carry out an endovascular procedure that involves guiding a micro catheter through the person’s arteries to the site of the aneurysm rupture.
Garcea ultimately made a full recovery from his stroke and although he returned to school a little more than a month after the incident, his physicians recommended that he forego playing soccer his senior year at Aquinas.
Reflecting on his brush with death and why he was able to make a quick recovery while so many others who suffer from these types of strokes are faced with a lifetime of disability began to shape Garcea’s decisions about his studies and career.
“I was fascinated about what had happened and began to become interested in learning more about the brain and what happens to people’s cognition and function after an injury,” said Garcea.
He attended St. John Fisher College and began studying cognitive psychology and biology. During his sophomore year in college, he got back into contact with Vates and spent the next year and a half as a research assistant in his lab at the University of Rochester Medical Center.
Around this time, Brad Mahon, Ph.D. joined the University of Rochester as an assistant professor in the Departments of Brain and Cognitive Sciences, Neurosurgery, and the Center for Visual Science. Mahon’s research focus was on how the brain recovers its function after injuries like a stroke or after surgery to remove a tumor.
Garcea began working with Mahon in the summer of 2009 and, after finishing his undergraduate studies in May of 2010, was hired as a full-time research assistant in Mahon’s lab. This experience propelled Garcea to apply for a Ph.D. position in the Department of Brain and Cognitive Sciences at the University of Rochester. Garcea completed his Ph.D. degree in July 2017 and is about to start his post-doctoral fellowship at the Moss Rehabilitation Research Institute in Philadelphia and the University of Pennsylvania.
“Looking back, the stroke that could have very easily killed me or robbed me of my health instead ended up shaping my life in a very profound way,” said Garcea. “My goal is to study cognitive function in individuals with brain injury to develop a deeper scientific understanding of brain function, with a clinical goal of identifying novel therapeutic techniques for patients as they recover from stroke or a tumor.”
“For me, there is indescribable pride in knowing that the critically ill boy I treated years ago has taken the cards dealt to him by fate and matured into a great young scientist with such incredible potential,” said Vates.