Neurosurgeon Robert Starke, M.D., with UHealth – the University of Miami Health System successfully diagnosed and surgically treated a former chief medical officer from the Bahamas who suffered a rare vascular condition in the brain.
In December 2016 Glen Beneby, M.D., then chief medical officer for the Bahamas, suddenly blacked out and collapsed. He then experienced cognitive decline and weakness on the left side of his body. After seeing various doctors and being misdiagnosed, he came to Miami, where he was referred to Starke.
Starke and Beneby detailed his rare condition, treatment and remarkable comeback at a May 16 news conference at the University of Miami/Jackson Memorial Hospital.
“When I first met Dr. Beneby, he was wheelchair-bound, and could only say his name,” Starke said. “As I took a closer look as his older MRIs, I was able to see hundreds of abnormal vessels and severe swelling in the brain.”
Doctors in the Bahamas had initially suspected a brain tumor, but ruled that out. After conducting a series of tests, including an MRI, doctors diagnosed Beneby with dural venous sinus thrombosis, a condition that creates clots in the main veins in the brain. He was immediately placed on anticoagulants, commonly known as blood thinners.
Although he took medication, his condition worsened in a period of three months. Over the next year, he saw a variety of doctors and was thought to have progressive dementia of unclear etiology.
“I could no longer dress myself, and I began walking slowly,” Beneby said. “I was losing understanding of basic things; I also started having seizures.”
His wife could not bear the anguish of seeing her husband rapidly deteriorate.
“He was normally very active and sharp,” said Carolyn Beneby. “He could no longer carry a conversation, and he had lost his ability to smile and show any expression.”
In June 2017, Beneby was transferred to a Miami hospital, and was later referred to Starke, a neurologist, neuroradiologist and co-director of endovascular neurosurgery at Jackson Memorial Hospital.
Starke immediately ordered an angiogram, which provides videos of the blood as it moves through the brain, and diagnosed Beneby with a rare condition called cerebral dural arteriovenous fistula (DAVF). DAVF is a vascular anomaly formed by an abnormal connection between an artery within the lining of the brain, and a vein that carries blood from the brain back to the heart.
This rare condition is usually diagnosed in patients in their 50s and 60s, and is classified by three types. Type I is considered benign and shows minor symptoms or none; type II may cause hemorrhage, seizures, and neurological deficits; and type III may cause the patient to experience hemorrhage, seizures, stroke, and neurological deficits.
Beneby was diagnosed with Type III, and even though he had not experienced any bleeding or a stroke, the end result could have been fatal if left untreated.
“Aside from experiencing seizures and severe cognitive decline, Dr. Beneby was also experiencing swelling in the brain,” said Starke. “Luckily, his veins were able to compensate.”
Although this condition is rare and challenging to treat, Starke receives referrals and treats patients locally, nationally, and internationally who have been diagnosed with abnormal brain and spinal vascular disorders. Starke is one of the few doctors who practices all treatment options including microsurgery, embolization, or focused radiation therapy. For each type of DAVF, there is an optimal treatment.
Beneby underwent endovascular embolization, a minimally invasive procedure in which Starke placed a catheter through the leg and passed it through the artery until it reached the DAVF. The fistula was then plugged with glue to correct the abnormal pattern of blood flow.
Shortly after the procedure, Beneby underwent occupational, physical, and speech therapies at Jackson Rehabilitation Hospital for four weeks.
“Just a few weeks after the procedure, my husband was smiling again, and carrying conversations,” said Carolyn Beneby. “I felt so happy to have my husband back.”
Beneby returned to work in December 2017, and transitioned into a new role as director of special projects for the Health Department in the Bahamas.
“This whole experience truly confirmed my faith in God and life,” said Beneby. “I feel I have a special purpose in life. This is a transformation, and it’s a true miracle by definition.”
Beneby is excited to focus on continuing to create medical programs in his country, including collaborating with UHealth to provide better access to patients suffering from neurological conditions.