Disease of the Month – Cerebrovascular Disorder by Dr. Michael Moussouttas

The term “cerebrovascular disorders” refers to a constellation of thromboembolic and hemorrhagic diseases of the arteries and veins that contribute to perfusion of the central nervous system (CNS). Cardioembolic processes involve intracradiac thrombi embolizing to and occluding CNS vessels, and are due to such processes as atrial fibrillation, coronary artery disease with myocardial hypokinesis, or valvular problems. Thromboembolic disease involves atherosclerosis of the large vessels which arise from the heart (aorta) and travel to the neck (carotid or vertebral arteries), which may culminate in the development of thrombosis with embolization to cerebral vessels. Atherothrombotic disease involves a similar process within the large cerebral intracranial vessels, and lipohyalinosis pertains to chronic hypertrophic stenotic changes within the small penetrating cerebral arterioles that may result in lacunar infarction. Thromboembolic and atherothrombotic processes are collectively referred to as large vessel or macrovascular disease, whereas lipohyalinotic processes are considered small vessel or microvascular. Hemorrhagic cerebrovascular disease relates to rupture of small cerebral vessels causing intracerebral hemorrhage, or of larger cerebral vessel aneurysms that results in subarachnoid hemorrhage (hemorrhage into fluid surrounding the CNS). Venous sinus thrombosis and cerebral venous thrombosis relate to thrombotic events in the large cerebral venous sinuses and smaller cerebral veins respectively.

Cerebrovascular disease is currently the leading cause of disability in modernized societies such as the United States and the European Union, and is the 4th leading cause of mortality after heart disease, cancer and lung disease. Major risk factors for cerebrovascular disease include hypertension, diabetes, hyperlipidemia, atrial fibrillation, coronary artery disease, tobacco use, excessive alcohol use, inactivity, obesity, male gender and older age. Since most of the risk factors are modifiable and can be ameliorated by lifestyle changes or by medications, the risk for a cerebrovascular event can be substantially decreased and prevented if action is taken in a timely fashion. Male gender and older age represent the only nonmodifiable risk factors that cannot be changed. Reducing tobacco use, which is markedly prevalent in some Mediterranean countries and cultures, may represent a particularly important target in reducing the incidence of cerebrovascular disease.

Cerebrovascular events typically present with acute symptoms which are typically focal or lateralized, and which localize to the damaged area of the CNS – aphasia (expressive and/or receptive language dysfunction), spatial deficits (neglect and extinction), facial asymmetry, dysarthria, dysphonia, dysphagia, visual loss, hypsesthesia, and paresis. The development of any of these symptoms warrants emergent evaluation including cerebral imaging with CT or MR imaging. Radiologic imaging will demonstrate whether the process is ischemic due to vessel occlusion or hemorrhagic due to vessel rupture, and will thus dictate the most appropriate therapeutic course of action. Whereas management of intracerebral hemorrhage is limited to acute treatment of hypertension, management of subarachnoid hemorrhage involves endovascular coiling or surgical clipping of the ruptured aneurysm, and potentially the need for additional ancillary treatments for the many potential complications that may follow SAH. Cardioembolic, macrovascular thromboembolic & atherothrombotic, and microvascular processes compromise perfusion and result in cerebral (or spinal) ischemia that may progress to permanent damage, or infarction. Treatment for such ischemic processes involves the emergent administration of thrombolytic therapy in the form of intravenous tissue plasminogen activator (tPA), and sometimes the endovascular removal of occlusive thrombi (thrombectomy). Generally, tPA may be given within the first 4 ½ hours following an acute ischemic event, and thrombectomy may be performed within 6-8 hours after the onset of symptoms, depending on the amount of viable tissue as determined by special CT or MR perfusion scans in conjunction with CTA or MRA vessel imaging scans to identify the involved vessel.


About the author:

Doctor Moussouttas completed residency training at Mount Sinai Medical Center in New York City, subspecialty training in Cerebrovascular Diseases at Yale New Haven Hospital in New Haven CT, and additional subspecialty training in Neurocritical Care at Columbia University Medical Center in New York City. Doctor Moussouttas is board certified in Neurology by the American Academy of Neurology, Cerebrovascular Diseases also by the American Academy of Neurology, Neurocritical Care by the United Council for Neurologic Subspecialties, and in Neurosonology by the American Society for Neuroimaging.

Doctor Moussouttas has participated as an investigator in numerous multicenter clinical trials, has initiated several investigator initiated research projects, and has published numerous articles on cerebrovascular and neurocritical care research in several peer reviewed journals. Doctor Moussouttas’ interests include subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral ischemia.

Doctor Moussouttas is currently a neurointensivist in the Capital Institute for Neurosciences at Capital Regional Medical Center in Trenton NJ.

Member of the Month – Alexia Tsikouras, PharmD

IMG_3375 Alexia Tsikouras, PharmD

Tell us about yourself


My name is Alexia Tsikouras and I was born and raised in the Art Museum area of Philadelphia PA. I earned my Doctor of Pharmacy degree from the University of the Sciences in Philadelphia in 2008. From 2008 until early 2014 I worked for CVS Pharmacy. I now work at Penn Presbyterian Medical Center, which belongs to the University of Pennsylvania Health System along with Hospital of the University of Pennsylvania and Pennsylvania Hospital.



Where do you work in the healthcare field?


At Penn Presbyterian I run the MyPenn Pharmacy program which provides medications to patients before they are discharged from the hospital. I also head the MyPenn Specialty Oncology Program, that provides oral chemotherapy medications to outpatients of the Abramson Cancer Center branch at Penn Presbyterian. Both programs provide great services to all patients.


What is your connection to Greece?


My parents are from the Epirus region of Greece, specifically a small village town 20 minutes from the main city of Ioannina. I visit that area of Greece just about every summer along with various Greek Islands and Athens. I am proud to be an Epirotisa! I am an active member of St. George Greek Orthodox Cathedral in Center City. I also attended Greek school there and was part of the Brotherhood of Demati Dance Group.


Why did you choose to become an HMS member?


I am very proud of my Greek heritage and believe the work ethic that was instilled in me by both of my parents has gotten me to where I am today professionally. HMS has given me the opportunity to give back to the community especially to students who are interested in healthcare professions. HMS gives the extended Greek community of the tristate area an opportunity to network and meet with different healthcare professionals in all areas of the healthcare field.


What do you do for fun?


I love to travel! My favorite cities are Paris, London, Miami and lets not forget the Greek Islands! I love to spend time with my family and friends!

Hellenic Medical Society invites members to attend Chronic HCV dinner lecture

Chronic HCV Treatment Guidelines:

Best Practices for Achieving a Cure

Dr. Nikolaos Pyrsopoulos, MD, PhD, MBA

Wednesday, December 2, 2015


Morton’s The Steakhouse

1411 Walnut St, Philadelphia, PA 19102

Reservation Required, space is Limited

Please check your email for invite

Hellenic Medical Society joins Networking Social among Hellenic organizations, Thursday November 5, 630 pm at UBAN

Dear Colleagues,

The  Hellenic Medical society invites you to a fall Networking event among the Hellenic Professional organizations of Philadelphia.
Meet members of the  Greek American Chamber of Commerce as well as American Hellenic Lawyers Association in a causal social setting as we usher in the Holiday season.  This impromptu event gives all of us an opportunity to slow down, meet and mingle among friends.  Please bring a friend to learn about the various organizations and bring your cards!

When: Thursday November 5th

Where: UBAN, 1314 Chestnut Street, Philadelphia (Next door to BRU)

Time: 6:30 to 8:30 pm

Costs: FREE FARE for all members and friends of the Society and cash bar!

Having an evening of mingling with Greek friends,  professionals and businessman: Priceless!


Looking forward to seeing you there.

Hellenic Medical Society Supports Rebuilding St. Nicholas Concert.

The Hellenic Medical Society of Philadelphia is supporting the Federation of Hellenic American Societies of Philadelphia and his Eminence Metropolitan Evangelos of New Jersey is efforts to rebuild St Nicholas Greek Orthodox Church at Ground Zero.

Please join the Society in support through attending this concert.

Member of the Month, June 2015: Elias A. Iliadis MD FACC




  1. Who are you and what do you do professionally?

I was born and raised in Freehold, New Jersey and worked in my family’s restaurant (as many did) through college and medical school (Rutgers Med).  Training consisted of Internal Medicine at Jefferson, Cardiology at Rush Presbyterian in Chicago and Interventional Cardiology at University of Michigan in Ann Arbor.   I was recruited to Cooper University Hospital as associate director of the cardiac cath lab and director of Peripheral vascular interventions and vascular medicine program for the last 12 years.

  1. What is your career?

My practice is focused on the treatment and prevention of cardiac and vascular disease while teaching residents and fellows.  My cardiology practice is both primary and secondary prevention including treatment of acute coronary syndromes and chronic coronary artery disease with cath lab based and office based treatments.  My peripheral vascular practice consists of treatment of arterial and more recently venous disease including pulmonary venous disease.

  1. What is your connection to Greece?

My father and mother were from Pontos and came to the United States to seek a better life for themselves and their family.  They instilled the classic immigrant mentality of hard work and education in me and my brothers (Engineer and business owner).  I married a woman I met in Greek class in college (Katherine Dedes) and kept my family in the Greek community wherever we lived.

  1. Why are you an HMS member?

I believe it is our responsibility to shape the future of our community and support the youth in medical careers.  I was the recipient of the New York Hellenic Medical Society scholarship and felt we can bring that level of involvement here also.  I applaud those who give scholarship support to students but I also believe the HMS, through our contacts, can support students through giving them a career opportunity.

  1. What do you do outside of your profession?

My family and I enjoy our shore home in Delaware and sharing our time with family and friends.  We have become the Crew parents during rowing seasons, Softball parents during softball season and St Joseph’s parents during the college year.  We follow our kids; it’s what Greek parents do.

Hellenic Medical to co-host Event June 30th at Estia in Support the CLEO Children’s initiative in Greece.

The Board of Directors of the Hellenic Medical Society is co-sponsoring a dinner at Estia, June 30th in support of the CLEO initiative in Greece under the direction of HMS member Dr Theo Zaoutis of Children’s Hospital of Philadelphia and University of Pennsylvania Medical center.

June 30 from 6 to 8 pm

Estia Restaurant

Philadelphia PA

Costs/Donations; 40$ minimum

CLEO (Collaborative Center for Clinical Epidemiology and Outcomes) was established in 2011 to reduce pediatric infections and diseases occurring in hospitals across the country of Greece. The death rate of children resulting from infections contracted while hospitalized in Greece is 5 times that of any other European country.  CLEO, partnered with the Stavros Niarchos Foundation, is addressing this by educating and training Greek physicians, nurses, and health care technicians on the proper disinfecting procedures and protocols.

Please join Dr. Theo Zaoutis, Pediatric Infectious Disease Specialist at Children’s Hospital of Philadelphia, as he educates us on how this issue has evolved alongside Greece’s economic crisis, the current challenges faced by the hospitals and patients in Greece, and how we can assist our brethren.

Sponsored by: Hellenic Medical Society of Philadelphia, (AHEPA – Hercules-Spartan Chapter26, Daughters of Penelope Tritonia#129, National Hellenic Student Association (National/Philadelphia),

Please come out and support his efforts to improve the care of Children in Greece.

For a flyer, click below:


May 9th Greek Concert to benefit the Hellenic Medical Society’s Student Scholarship fund.

In cooperation with Apollo Presentations LLC, The Board of Directors of the Hellenic Medical Society of Philadelphia gladly supports the May 9th Greek Concert by acclaimed singer Yiannis Parios at Atlantic City’s Tropicana Casino.  Apollo Presentations will graciously donate a portion of each ticket sold to the Student Scholarship fund of the Medical Society.  Please consider attending this great concert and support the educational needs of our Hellenic Students.

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Tickets may be purchased at



Hellenic Medical Society Supports the Hellenic Relief Foundation with Donation from 2015 Vasilopita Celebration

The Hellenic Medical Society in association with Greek American Chamber of Commerce, Hellenic American Lawyers Association, Hellenic University Club, Greek American Heritage Society of Phialdelphia held the 2015 Vasilopita celebration at Estia in January.  The proceeds of the event as well as the proceeds from the combined christmas party (Hellenic University club hosted) were presented to Mr Philip Vogis and board members from  Hellenic Relief foundation.  In this spirit of renewal and hope, these monies are used to provide food for needy families in Greece from Greek producer and farmers. To date, the Foundation has donated nearly $225000 in food and is actively pursuing more avenues of support.  We applaud the efforts of the Hellenic Relief Foundation and all charities working in Greece during this time of need.

For further details of the charity, contact the Hellenic Relief foundation at www.hellenicrelief.org.

Greek American Chair Dr Iliadis, Hellenic Medical President Tzaferos, Hellenic Relief fund Mr Vogis, Hellenic University Club Mr Pappas and Board member during check presentation

Greek American Chair Dr Iliadis, Hellenic Medical President Tzaferos, Hellenic Relief fund Mr Vogis, Hellenic University Club Mr Pappas and Board member during check presentation

Member of the Month February 2015, Roxane Hionis, MD


Roxane Hionis, MD

1. Who are you and what do you do professionally?

 I grew up in Euclid, Ohio, just outside of Cleveland.  After graduating from Brown University, where I double  majored in Biology and French Literature, I returned to Cleveland to attend medical school at Case Western Reserve University. I completed my residency in Internal Medicine at Hahnemann University in Philadelphia where I met my husband, Dr Sean Janzer, who is an interventional cardiologist at Einstein Medical Center. We have three lovely daughters.

2. what is your career?

My practice is focused on the treatment and prevention of disease in adults.  By virtue of my being a woman, the majority of my patients are women and, thus, I have developed an interest in women’s medicine.  (However, I do still treat many men in my practice!) My goal is to provide high quality health care to the patient as a whole, considering the interplay of psychological status, life circumstances and physical disease. I also aim to help patients live a healthier life in order to prevent many of the diseases that plague our society today.  

3. What is your connection to Greece?

My father is from Kefalonia.  He came to the United States to do his residency in ophthalmology. While completing his internship in Canton, Ohio, he met my mother whose family came here from Pontos.  In Cleveland, I attended Sts. Constantine and Helen Cathedral. My Greek heritage was a big part of my life growing up. I attended Greek school and was a member of the dance group at St Constantine’s for many years.  I still have many cousins, aunts, uncles and friends in Greece and we visit them every few years.  

4. Why are you an HMS member?

I believe that my Greek heritage has shaped who I am as a person and as a physician. I enjoy meeting and networking with other Greek professionals and have a desire to support the community as much as possible.  (I also have a lot of Greek patients who would like me to refer them to Greek doctors and this is a good way to meet them!)

5. What do you do outside of your profession?

My family and I love to travel, especially to Greece and other parts of Europe. I love to dance and have branched out from Greek dancing to Middle Eastern dance.  My next goal is to learn some ballroom dance but I am inhibited by the fact that my husband does not share my love of dance. I also enjoy reading, cooking, the beach, learning foreign languages (working on number 4) and spending time with my family.