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Tiffany Scholl is back to full health after suffering  a major stroke at the age of 31.

She had developed two complications of pregnancy: HELLP syndrome, which causes thinning of the blood, and eclampsia, which causes high blood pressure and convulsions.

Tiffany, a Toronto hairdresser, was rushed to Sunnybrook, where doctors went into high gear to save her life. She had suffered a brain hemorrhage deep within the left side of her brain. She had experienced an epileptic seizure. She was in a coma.

There were other medical problems: She developed significant swelling in her brain, so the neurosurgery team was on stand-by in case she needed emergency surgery. The blood vessels in her brain went into spasm with severe narrowing. One of the major arteries in her brain had partially torn and developed a blood clot, posing an immediate risk for another stroke.

While Tiffany lay unconscious, an obstetrical team delivered her baby by emergency C-section at just 29 weeks gestation. It was June 23, 2013. Her baby girl, Clementine, only survived until July 3. Dr. David Gladstone, a stroke neurologist at Sunnybrook, remembers how close Tiffany's husband, Mario, came to losing both his daughter and his wife. "It was very tense. We were hoping for a miracle," the doctor says.

Choosing her treatments posed a dilemma. "On the one hand, she needed blood thinners to prevent more clotting. But on the other hand she had bleeding in the brain that made any treatment more risky. It was a delicate balance," says Dr. Gladstone. Tiffany was in good hands, as Sunnybrook is one of Ontario's Regional Stroke Centres and has the expertise to tackle the province's most dire cases.

After several days in a coma, Tiffany woke up. Because of the stroke, she had lost her ability to comprehend, to remember and to speak. She was paralyzed in her right arm and right leg.

"People told me that I had had a baby and that it had died. I didn't understand. I started crying and fell asleep," says Tiffany. "It was better that I didn't understand."

Sunnybrook is also a leader in poststroke psychiatric symptoms. When Tiffany later became angry, agitated and delirious, the psychiatry team was called in to consult.

Tiffany stayed at Sunnybrook for two months and steadily improved in every way, relearning to walk and talk. Another two months in a rehabilitation centre, and she was ready to go home.

Now, just over a year later, Tiffany is back at work and actively participating in both running and cycling fundraisers. "Someone who doesn't know me would never know I had a stroke," she says.  She is very keen to try again to have a baby, and will be cared for in Sunnybrook's High-Risk Stroke and High-Risk Pregnancy clinics.

Her remarkable recovery is a testament to both the resilience of the human brain and Sunnybrook staff's expertise and teamwork across disciplines. "They were pretty awesome," says Tiffany. "They took good care of me."

Helping people recover their brain health is one of Sunnybrook's most urgent priorities. The reason is obvious: It's difficult to find a family, community or workplace completely untouched by either a disorder of the brain, such as stroke, dementia and trauma, or a disorder of the mind, such as depression, anxiety and addiction.

Within seven years, brain diseases will become the leading cause of death and disability in Canada. "We are dealing with the most compelling and devastating illnesses that are going to face us in the next 50 years," says Dr. Sandra Black, Sunnybrook's director of the Brain Sciences Research Program. The program is guided by the principle that only through cross-disciplinary collaboration will scientists find the necessary answers to guide them – psychiatrists working with neurologists working with neurosurgeons working with neuropharmacologists, family doctors and neuroimaging experts, as well as nursing and allied health teams.

To fortify these connections permanently, Sunnybrook is creating a new, state-of-the-art Brain Sciences Centre to house these experts under one roof. The new space will send a message to patients, whether in the youth psychiatry division – the largest in Ontario – or cognitive neurology or stroke recovery: "We care about you." A lead gift has made this dream possible and, with efforts under way to raise awareness, additional private donations will make it real.

Working collaboratively across disciplines has a tangible impact on patients in two important ways. One is that embracing psychiatry inside brain sciences gives it the same status as any illness, reversing centuries of ill-treatment when "mental" patients were ostracized and isolated. "Fighting stigma is part of the reason mental illnesses are aligned with brain sciences. They are all brain sciences," says Dr. Black.

The other reason: Each disorder of the mind, brain and body teaches researchers and clinicians something about the others. Sunnybrook has unearthed some surprising new discoveries that wouldn't have been possible if psychiatry were still in its own silo. For instance, a significant number of stroke patients like Tiffany develop psychiatric illness after their stroke because of brain changes.

"How is mood affected by stroke? How is cognition affected by heart disease? How can dementia cause depression? Our whole team thinks along that line. You ask those questions because you are thinking of the brain," says Dr. Black.

Sunnybrook psychiatrist Dr. Anthony Feinstein
is a world-leading expert in conversion disorder.

Photo by Doug Nicholson

Another fascinating example of the brain, mind and body interface is a psychiatric illness called conversion disorder. Sunnybrook psychiatrist Dr. Anthony Feinstein is a world-leading expert in this field.

"The mind can turn off the body," he says of the condition, in which psychological stress is revealed in physical ways. One of his most dramatic cases was a young man who came to Sunnybrook in a wheelchair. The man had lost all sensation in his legs and one of his arms. While symptoms certainly mimicked a stroke, Dr. Feinstein suspected conversion disorder. With the man's permission, Dr. Feinstein gave him a strong sedative to suppress anxiety and allow him to talk freely about things that had been repressed. The man explained that he had been sexually abused and never told anyone. Why would this cause numbness?

Dr. Feinstein, alongside colleagues from the University of Waterloo and the University of Toronto, recently completed a study to find out. They first needed to develop an instrument that would stimulate a paralyzed limb while the patient was inside a functional MRI machine.

They studied 10 subjects with conversion disorder, one of the largest samples reported to date. They applied stimulation to the paralyzed limb, and brain imaging showed an overactivation in the brain's limbic system, which controls emotion, behaviour, motivation and memory.

At the same time, they observed suppression of the brain's sensory system. Sure enough, psychological pain shuts down body functions. "Conversion disorder is the most florid manifestation of this interplay between emotion and physical symptoms. What you feel influences physical functioning. Freud would be vindicated if he saw this result," says Dr. Feinstein. Their study was presented at the recent American Academy of Neurology annual meeting in Philadelphia.

The patient's treatment included talk therapy and medication. He is walking now, and able to catch a ball with the arm that was previously paralyzed. (We have changed some details to protect anonymity.)  "The diagnosis, treatment and recovery of conversion disorder highlights why Sunnybrook's collaborative methods are beneficial," says Dr. Feinstein. "To make this discovery, we needed imaging expertise, plus psychiatry, plus neurology, working together."


Two colleagues of Dr. Feinstein's are also exploring interesting frontiers at the interface between brain, mind and body. Psychiatrist Dr. Nathan Herrmann and neuropsychopharmacologist Dr. Krista Lanctôt are using sophisticated brain imaging to find out whether lithium,
a common psychiatric medication, can successfully help regenerate and grow brain areas after a stroke. The study is funded by the Heart & Stroke Foundation. If lithium is successful in increasing grey matter, it will be an example of a mind medication being used in a brain disorder. "Having medications that support brain recovery after a stroke is a major unmet need right now," says Dr. Lanctôt.

Another study by Drs. Herrmann and Lanctôt will test why people with coronary artery disease (CAD) have a stronger risk of depression and cognitive decline.  They believe one of the reasons is that certain byproducts of fat breakdown involved in the development of CAD, called ceramides, can harm brain cells. Ceramides are overproduced in response to inflammation, a key feature of CAD.

They are recruiting 129 CAD patients from a cardiac rehabilitation facility to test this theory. Results from this study, which is funded by the Canadian Institutes of Health Research, may be helpful in developing new treatments to prevent memory decline in patients with CAD.

"We believe there is definitely a relationship between the mind and the body. By finding out the links between disease states and what's going on in the brain, we hope to find new treatments," says Dr. Herrmann.

Sunnybrook is answering the urgent call to learn more about this amazing three-pound organ, the brain. While not all patients do as well as Tiffany did, Sunnybrook's dedication to collaborative care and research across physical and psychological disciplines sets the stage for recoveries such as hers. "It is truly incredible that she survived and has been able to rehabilitate and recover so well – physically, cognitively and emotionally," says Dr. Gladstone. "This is the type of excellent recovery that we wish all our patients with stroke and brain injury can achieve."

This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.

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