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Introduction

Vascular neurology is an area of medicine in which selected neurological disorders involving the central nervous system due to ischemia or hemorrhage are assessed, monitored, treated and prevented using a combination of clinical evaluation, imaging, interventional techniques, and medication. Specialists in vascular neurology are expected to:

  • Participate in the interdisciplinary care of patients with vascular disease that  incorporates aspects of epidemiology, basic science, clinical neurology, neuroimaging, critical care, endovascular surgical neuroradiology, neurological vascular surgery, neurosurgery, neurosonology, cerebral blood flow and metabolism, neurobehavior, and neurorehabilitation
  • Acquire detailed knowledge of the vascular supply of the central nervous system and its alteration by disease
  • Manage stroke patients in outpatient and inpatient settings, including critical care units
  • Vascular neurology includes the prevention, evaluation and treatment of a wide range of diseases resulting in vascular insults to the nervous system, including:
    • Cardiogenic brain embolism
    • Large vessel cerebral atherosclerosis
    • Aortic arch cerebral and spinal embolism
    • Small cerebral artery occlusive disease
    • Hemodynamic brain ischemia
    • Migraine
    • Hereditary and acquired hypercoagulable states
    • Disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, other hematological disorders
    • Antiphospholipid antibody syndromes
    • Substance abuse and drug toxicities
    • Hypertensive encephalopathy
    • Arterial dissection
    • Vasculopathies including inflammatory, infectious, Moya-moya
    • Cerebral venous thrombosis
    • Genetic and metabolic disorders
    • Intracerebral hemorrhage
    • Aneurismal subarachnoid hemorrhage (SAH)
    • Subdural hematomas
    • Spinal cord infarction
    • Complications of vascular disease, including raised intracranial pressure, sepsis and venous thrombosis
    • Vascular malformations

Optional Neurohospitalist Track

The neurohospitalist role is emerging as an in-demand new subspecialty of neurology. Many office-based neurology groups are actively seeking new members to take over the care and consultations of patients in the ED and the wards of their affiliated hospitals. Despite this growing need, there are as yet no formal guidelines for training in this field. Vascular neurology is the most complementary subspecialty training for this role, as a large portion of inpatient and ER neurology consults are for stroke and stroke mimics, and vascular neurologists often diagnose and manage neuroemergencies other than stroke as they are often the first neurologists called to the bedside of neurologically-ill appearing patients.

We offer an optional track for interested fellows to pursue additional training in this nascent field during the vascular neurology fellowship. The fellow would devote the majority of their elective time to this additional training, which would include additional exposure to non-stroke neurological inpatients (both on and off the neurology service) and ED consultations. Interested fellows would work with the program director to design a course of clinical and educational activities to accomplish this training. A major focus would be on the diagnosis and management of neuroemergencies, defined as a clinical entity that could lead to death or disability, and where the outcome may be improved with prompt recognition and treatment.