UHealth Neurosurgeon Cures Rare Brain Disease and Prevents Stroke in Young Air Force Trainee

University of Miami Health System neurosurgeon Jacques J. Morcos, M.D., has solved the puzzling symptoms of 28-year-old Paul Casas. Diagnosed with Moyamoya disease, a progressive condition constricting arteries of the brain and depriving it of blood flow, Casas received a double-barrel STA-MCA bypass from Morcos at Jackson Memorial Hospital. Four days later, Casas was discharged from the hospital, cured.

“A lot of things in medicine make me smile and this is one of them,” Morcos said at a June 6 press conference where the internationally renowned neurosurgeon and authority on bypass surgery explained Casas’ case and procedure.

“It was essentially rebuilding a new artery on the right side of his brain, and luckily it was very successful,” said Morcos, Director of Cerebrovascular Surgery and Skull Base Tumor Surgery and one of the few neurosurgeons in the world who performs the bypass procedure.

Casas first became aware of the symptoms last year during special-ops military training in San Antonio, Texas. His left arm would often go numb, his memory began deteriorating, he suffered frequent headaches, and studying became more challenging. However, the married father of two daughters dismissed the symptoms, attributing them to the intensity of the exercises in training. When his headaches became a daily thing, he checked into the military hospital on base.

In April 2017, MRI and CT scans of his brain led doctors to diagnose Casas with Moyamoya disease on the right side of his brain. Moyamoya is a rare type of stroke disorder that causes the carotid artery and the arteries inside the brain to slowly close off, giving young patients repeated strokes and sometimes bleeding in the brain.

“I was discouraged with the news because I was so close to finishing my training,” said Casas. “But ultimately my health came first, because I had to be there for my daughters, wife and family.”

Casas sought a solution, but says that instead he found a lack of knowledge and resources to cure Moyamoya. His wife, Stephanie Casas, left their Miami Lakes home to help her husband consult with universities and hospitals across the nation. Many advised them to just “wait it out,” but they didn’t want to take the risk that Casas’ condition would worsen, causing a stroke or hemorrhage.

Ultimately, they contacted a friend who was familiar with the work performed by the physicians in the Stroke Division at the University of Miami Department of Neurology. They sent Paul’s information to one of the stroke neurologists, Amer Malik, M.D., MBA, assistant professor of clinical neurology, who was able to review the situation and neuroimaging performed to date.

He suspected Moyamoya was the diagnosis but additional investigations needed to be completed on an emergent basis to confirm the condition. He also advised that if the Moyamoya diagnosis was indeed confirmed, his colleague, Morcos, one of the most experienced neurosurgeons in the country, would be able to perform the necessary surgery.

Morcos’ expertise includes treatment of cerebrovascular diseases (stroke, carotid stenosis, aneurysms, vascular malformations, and cavernous angiomas) as well as complex tumors of the brain, and the base of the skull (meningiomas, pituitary adenomas, acoustic neuromas, malignant tumors and others) at UHealth and Jackson Memorial Hospital.

“As soon as the military gave Paul permission to leave, we drove from San Antonio to Miami,” said Stephanie.

Paul was admitted to the inpatient stroke service at Jackson under the supervision of Sebastian Koch, M.D., professor of neurology, and Erika Marulanda-Londono, M.D. Morcos evaluated the patient and noted that “a large part of the right side of the brain was ‘hungry’ for more blood flow. We call it misery perfusion,” said Morcos. “The best approach in Paul’s case was to perform a surgery that would essentially give him a new artery to supply blood flow to the right side of his brain.”

Morcos uses the superficial temporal artery to middle cerebral artery (STA-MCA) bypass to treat complex aneurysms, select cases of stroke, Moyamoya disease and even as part of removing complex brain tumors. The delicate surgery uses a suture five times thinner than a human hair.

The four-hour surgery took place on Wednesday, May 24. Casas’ symptoms immediately disappeared, and he was able to go home four days after surgery, on Memorial Day weekend — a fitting date for this young special ops trainee.

“His thinking and memory immediately became much clearer,” said Morcos. “He even surprised his wife by remembering things he would normally forget like his daughters’ birthdays.”

“When I finally saw Paul, he was bandaged and I was scared,” said Stephanie. “But when he saw me, the first thing he asked was if I had already had lunch, and I knew then that everything was going to be all right.”

The family is thankful for the attention of the neurosurgery team and the ER and ICU teams at Jackson Memorial Hospital for their nurturing support and care during this challenging time.

“With Dr. Morcos fixing me, I’m definitely excited to get back into school and start studying again and see the difference that this extra blood flow to my brain is going to make,” Casas said. “I never felt like I was missing out on life’s little things until this diagnosis.”

Tags: Air Force, brain surgery, Jacques Morcos, Moyamoya disease, neurosurgery, Paul Casas, special-ops