Both hospital settings for the Vascular Neurology Fellowship Program are among the most advanced and innovative in their respective peer groups. Individually, each hospital Stroke Program director is nationally and internationally recognized for their academic and clinical contributions and are members and leaders of numerous organizations, Editorial Boards of prestigious journals, and multi-center trials. Their work is funded by National Institutes of Health, Department of Defense, Department of Veterans Affairs, and other federal, private and non-profit organizations. The fellow will be exposed to the latest clinical information and the potential to interact with other leaders in Vascular Neurology throughout the region, state and nation.
Baylor St. Luke's Medical Center Stroke Program
Baylor St. Luke's is the major private teaching affiliated hospital of BCM, and a DNV-certified and State of Texas designated Comprehensive Stroke Center and a Gold Plus Honor Roll of the AHA Target Stroke Program. There is a dedicated 40-bed Neurology floor, dedicated 20-bed neurocritical care unit, a 38-bed in-patient rehabilitation unit, and a neurosonology laboratory where ancillary staff is trained in the management of neurologic diseases.
There is very close collaboration at Baylor St. Luke's between vascular neurology, neurocritical care, general neurology, neurosurgery, neuroradiology, emergency department, and physical medicine and rehabilitation. Fellows will have the opportunity to attend a weekly interdisciplinary neurovascular conference, a vascular neurology conference, and neurocritical care conference. In addition, fellows will be interacting with neurology and neurosurgery residents and neurocritical care fellows rotating in the various units, and participate in the telestroke program.
Michael E. DeBakey VA Medical Center Stroke Program
The MEDVAMC is the primary teaching setting for the Department of Neurology’s training programs, supporting 30 Neurology resident and fellow positions. Twenty seven Neurologists are credentialed at the MEDVAMC, making it the largest clinical Neurology service in the VA system with 3 Centers of Excellence and multiple specialty and general neurology programs. Advanced MRI and PET imaging is present on campus for both research and clinical applications. There are 6 core clinicians who lead the stroke care at the MEDVAMC. The focus is on differential diagnosis, acute and subacute therapy and secondary prevention.
Weekly joint meetings between the stroke program and vascular medicine provide a setting to discuss and plan approaches to common clinical conundrums encountered in complex stroke patients and to problem solve system of care issues. There are also close relationships with neuroradiology, and interventional neuro-radiology often participates in acute and subacute treatment planning. Cardiology provides "fast track" consults to the stroke service for evaluation of potential cardioembolic sources or co-morbid conditions. Rehabilitation shares the inpatient ward with neurology and provides a seamless transition to rehabilitation.
Vascular Neurology fellows will have month long rotations. They will be spending four months on the inpatient/consult service at Baylor St. Luke's and four months on the inpatient/consult service at MEDVAMC. Each fellow will have four months of electives in neurosonology, neuroradiology (1-2 months), and neurointerventional radiology (1-2 months). Fellows have a longitudinal clinic one half day a week where they follow patients in an active out-patient setting.
Neurosonology: At Baylor St. Luke's and MEDVAMC the vascular neurology fellow will work with registered vascular technologists (RVT's) in learning how to perform noninvasive studies of the cerebrovascular system via ultrasound technology. The vascular fellow will work with physicians experienced in interpreting the results of carotid ultrasound and trans-cranial Doppler. The fellow will also learn about the physics and biological principles behind the medical use of ultrasound technology. A one month rotation in the vascular laboratory is planned.
Neuro-interventional radiology: The vascular neurology fellow will work directly with interventional neuroradiologists to learn the indications and limitations of interventional neuroradiological techniques in regards to stroke management. The vascular fellow will observe and participate in interventional procedures as per the interventional neuroradiologist. The fellow will participate in outpatient clinics where potential candidates are evaluated for neuro-interventional procedures. The procedures include carotid and intra cranial stenting, intra-arterial thrombolysis (both mechanical and chemical), and endovascular treatment of intracranial aneurysms. One to two month rotations are planned for the vascular fellow depending on the interests of the fellow.
Neuroradiology: The vascular neurology fellow will learn about the indications and limitations of various diagnostic tests used to image the neuraxis. The fellow will work directly with neuroradiologist to acquire skills in interpreting these imaging studies. The imaging studies includes cranial and spinal magnetic resonance imaging (MRI) and computerized tomography (CT), magnetic resonance angiography (MRA), conventional cerebral angiography, carotid and cranial Doppler studies, single photon emission tomography (SPECT) and positron emission tomography (PET). One to two rotations are planned depending on the interests of the fellow.
A mandatory six week block of didactics is scheduled dealing with emergency management of acute ischemic stroke, intra-cerebral hemorrhage, sub-arachnoid hemorrhage, and subdual hemorrhage. Introductory lectures will be held on CT, CT angiogram, CT perfusion, MR imaging, MRA, and MR diffusion and perfusion imaging. Weekly stroke conferences, journal clubs, and mortality and morbidity conferences augment the educational experiences. Standard textbooks dealing with acute stroke care, neurocritical care, neurosonology, neuroradiology and interventional radiology are available at both sites of training.
The Vascular Neurology faculty has broad interests in different aspects of stroke research. Many are recognized leaders and published widely in the area of translational stroke, acute stroke research, health services research, clinical trial design and analysis, genetics and basic science of stroke. Mentoring program starting in the first year of fellowship program is possible for interested candidates.