Conditions We Treat

NewYork-Presbyterian/�ձ�avɫ��Ƭ Medical Center treats the full range of cerebrovascular diseases and injuries, including:

Ischemic Stroke

An ischemic stroke occurs when a vital blood vessel that supplies oxygen to the brain becomes blocked or "clogged" and reduces blood flow to part of the brain. Within minutes, brain cells and tissues begin to die from lack of oxygen and nutrients. Most strokes (85 percent) fall into this category. Our team uses advanced imaging procedures and electrodiagnostic testing to visualize brain function and anatomy to make an accurate diagnosis of ischemic stroke and to pinpoint the location of the clot. Tissue plasminogen activator (tPA) is the first treatment for people with ischemic stroke. This clot-dissolving medicine is effective when given within four-and-a-half hours of the onset of stroke symptoms in patients who do not have bleeding in the brain. Other medications may also be given to protect brain tissue.

For patients whose clots do not resolve with tPA or for whom tPA is no longer a treatment option, our doctors may use surgical procedures to mechanically remove a blockage in the brain vessel and restore blood flow (an approach called "mechanical revascularization"). Doctors insert a tiny catheter into a lower limb blood vessel and guide it to the blockage in the brain artery. They then use one of several mechanical devices to remove the clot by extraction or suction. Small doses of clot-busting medications can also be delivered through the microcatheter. NewYork-Presbyterian/�ձ�avɫ��Ƭ interventional neuroradiologist Pierre Gobin, MD, was part of the team that invented the MERCI Retriever, the first device created to remove blood clots in the brain. That advance led to the development and use today of even more effective devices.

Patients who have survived and recovered from a stroke are at high risk for recurrence. At NewYork-Presbyterian/�ձ�avɫ��Ƭ, our cerebrovascular specialists employ treatments designed to reduce the risk of a second stroke. These treatments include medical therapies such as blood thinners, statins, and blood pressure medications, as well as surgical procedures to enhance blood flow to the brain.

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Hemorrhagic Stroke

Hemorrhagic strokes occur when a blood vessel in the brain bursts, often due to longstanding high blood pressure, trauma, age-related blood vessel changes, congenital vascular malformations, or other less common reasons. When an artery bleeds into the brain, surrounding brain cells and tissues do not receive oxygen and nutrients. In addition, pressure builds inside the head, leading to swelling, irritation, and compression of surrounding tissues. About 15 percent of strokes are caused by bleeding. Examples include intracerebral, intraventricular, subarachnoid, subdural, and epidural hemorrhages.

Aided by the results of a thorough neurological exam and brain imaging (CT scan or MRI), our neurointensivists are able to provide rapid, accurate diagnosis and immediate treatment to patients with hemorrhagic stroke to control bleeding and to minimize secondary injury, such as that caused by tissue swelling. The subspecialized medical staff and equipment in the Neurological Intensive Care Unit ensure that patients who have had a hemorrhagic stroke receive continuous monitoring to prevent further brain injury and optimize recovery. Approaches to their care include controlling elevated blood pressure, normalizing blood clotting, controlling brain swelling, enhancing the flow of oxygen-rich blood to brain tissue near the injury, and regulating brain temperature to normal or below-normal levels to protect brain tissue. Patients who require neurosurgery to reduce swelling in the brain benefit from the exceptional skills of NewYork-Presbyterian/�ձ�avɫ��Ƭ neurosurgeons.

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Carotid Artery Disease

Patients with narrowing of the carotid arteries in the neck (which supply oxygen-rich blood to the brain) may have an increased risk of stroke if the blockage reaches a certain size. These patients may be managed with medication (such as medications that lower cholesterol levels and blood pressure, thin the blood, and treat diabetes) and lifestyle changes (such as eating a healthy diet, exercising, and avoiding smoking). NewYork-Presbyterian/�ձ�avɫ��Ƭ doctors also offer a variety of surgical and minimally invasive approaches to treat carotid artery disease and reduce a patient's risk of stroke, including:

• Surgery (endarterectomy) to remove plaque and clots from the carotid arteries.
• Bypass revascularization to surgically reroute the blood supply and bypass the obstruction in a blocked carotid artery.
• Stenting, a minimally invasive catheter-based procedure to insert a mesh tube to keep the carotid arteries open.
• Angioplasty, using a minimally invasive catheter-based balloon to widen a narrowed carotid artery.

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Aneurysms

An aneurysm is a bulge in the wall of an artery. While many aneurysms remain undetected, others may cause symptoms by pressing on nearby nerves or other tissue. An aneurysm that ruptures causes a hemorrhagic stroke and requires immediate medical attention.

Our doctors use imaging examinations to monitor the size of an aneurysm. When treatment is necessary, patients may undergo surgical "clipping" or endovascular embolization to stop blood flow to an aneurysm. Patients with ruptured aneurysms are treated in the Neurological Intensive Care Unit to monitor their brain health, minimize secondary brain injury, and reduce the risk of complications.

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Vascular Malformations

A vascular malformation is an abnormal collection or tangle of blood vessels within or around the brain. The malformations restrict or alter blood flow and are associated with bleeding. A patient may first be diagnosed with a cerebrovascular malformation after a hemorrhage or during evaluation for a seizure or headaches.

Our doctors use imaging tests to monitor the size of a patient's vascular malformation and to determine if treatment is necessary. Therapy may include coil or glue embolization to close off weakened arteries and reduce the risk of future hemorrhagic stroke; surgery to remove the abnormal blood vessels; or stereotactic radiosurgery to apply targeted radiation to destroy the malformation. NewYork-Presbyterian/�ձ�avɫ��Ƭ doctors regularly employ these approaches to treat vascular malformations with great success.

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Brain and Spine Trauma

The severity of a brain injury can range from a mild concussion to severe trauma resulting in coma, disability, or death. Similarly, a spinal cord injury may affect only some function of a single limb, or be so extensive that a patient is unable to move any limb or breathe independently.

�ձ�avɫ��Ƭ and NewYork-Presbyterian is a dedicated Level I Adult and Pediatric Trauma Center and features an integrated team of specialists who are able to care for all types of brain and spine trauma.

Our physicians collaborate with our colleagues in emergency medicine and surgery to immediately stabilize, diagnose, and treat patients who have endured injury to the brain and/or spine. Our approach includes a systematic assessment and a well-defined treatment plan to quickly stabilize the injury and to minimize the risk of secondary injury to nervous tissue.

Rehabilitation begins as soon as possible, often within days of stabilizing the injury, and is provided by a team that includes rehabilitation medicine physicians (physiatrists) and physical, occupational, and speech therapists.

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Infections

�ձ�avɫ��Ƭ and NewYork-Presbyterian neurologists are experienced in the diagnosis and treatment of brain and spine infections. Examples including meningitis (an infection of the membranes surrounding the brain) and encephalitis (an infection involving the brain tissue itself).

Infections may be caused by bacteria, viruses, fungi, parasites, or prions. Treatment of these infections requires early detection and careful monitoring to minimize secondary brain injury. Some patients may be treated with antibiotics or antiviral medications; others may need respiratory support to help them breathe.

The team of neurologists and neurocritical care specialists at our hospital provides continuous monitoring of patients with infections and employs therapies based on the latest medical advances.

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