Stroke and Critical Care
The Alan and Barbara Mirken Department of Neurology’s accomplished team of movement disorder specialists coordinate neurocritical care for life-threatening diseases of the nervous system including stroke, seizures, and brain tumors. In collaboration with the Beth Israel Medical Center’s emergency department, intensive care units (ICU), and dedicated post-ICU units, these NYC neurologists oversee the diagnosis, treatment, and rehabilitation of neurological critical care cases including:
- Brain tumors
- Neurosurgical post-operative patients
- Spinal cord compression
- Brain trauma, including subdural hematoma
Since timely and appropriate responses to neurocritical events can significantly determine a patient’s outcome, there is a state of the art stroke team available 24 hours, seven days a week at Beth Israel Medical Center’s Betty and Morton Yarmon Stroke Center. Neurologists at this New York State-Designated Stroke Center provide comprehensive consultations, supervise diagnostic evaluations and make treatment decisions with the help of specially trained nurses who are also stroke care experts.
In order to assist with the fast and accurate diagnosis of patients, the emergency department has its own equipment for computed tomography (CT) scan and access to magnetic resonance imaging (MRI). Additionally, the Neurology Department offers diagnostic and monitoring capabilities such as continuous electroencephalography (EEG) monitoring, portable EEG monitoring in the ICU and step-down unit setting, and transcranial ultrasound. Diagnostic angiography and carotid duplex ultrasonography are available within the Department of Radiology.
Treating Stroke and Critical Care Patients
Strokes are primarily cause by blood clots and, on an emergency basis, the stroke team administers intravenous thrombolytic therapy to break up and dissolve clots with very good response times, meeting all the Joint Commission standards of care for strokes. Transcranial ultrasound measures how a patient’s blood is flowing through blood vessels in the brain with reflected sound waves. When performed in the acute setting, this can assist in determining the cause of the stroke and may have a potential therapeutic role in enhancing the effectiveness of thrombolytic therapy.
The hospital also has a designated stroke unit/step-down unit used for both stroke and non-stroke neurological patients. This unit offers expert nursing care, intracranial pressure monitoring, full cardiac and respiratory monitoring, and dialysis capability.
Furthermore, the department is able to seamlessly transfer those patients in need of endovascular treatment (clot retrieval, intra-arterial thrombolysis, arterial stenting, or management of ruptured aneurysms) or neurosurgical intervention within either Beth Israel Medical Center or the larger Mount Sinai Health System system. There is also excellent cardiology and vascular surgery services available to deliver comprehensive care for patients with vascular disease.
After emergent critical care is delivered, the department supervises ongoing medical treatments for patients. The range of care can include:
- When appropriate, inclusion in clinical trials for new medications and protocols
- Educating a patient on lifestyles changes, for instance, improving diet and exercise regimes
- Physical therapy to improve and retain function
- Speech language pathology
- Occupational therapy to give patients adaptive living skills
- Practical and emotional support for the patient, caregivers and family, including various support groups and input from the department’s social workers
- Collaborative psychological and psychiatric counseling and evaluation when necessary to help patients with conditions (depression, anxiety) that can accompany the rehabilitation process
- Referrals to other medical disciplines as needed (surgeons or cardiologists, for example)
- Ongoing care and follow-up.
As concerned members of the community, our NYC Neurologists and other stroke specialists collaborate to provide stroke prevention education and screening outreach to the general public, with an additional focus on the Asian and Latin communities. All of the department’s stroke prevention materials are available in English, Chinese, and Spanish. Our stroke care professionals also work together to create stroke-treatment educational opportunities for physicians and non-physician practitioners. Since 80% of strokes can be prevented, the stroke and critical care team knows an educated public is a healthier one.