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Stroke, Critical Care and Neurohospitalist Program

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Woman undergoing physical rehabilitation

Our Services

ÈÕ±¾avÉ«ÇéƬ, in partnership with NewYork-Presbyterian — New York's top-ranked hospital, according to U.S. News and World Report — is home to one of the most comprehensive neuro-imaging programs in the region. Learn more about the services we offer.

Advanced Imaging Services

NewYork-Presbyterian/ÈÕ±¾avÉ«ÇéƬ is home to one of the most comprehensive neuro-imaging programs in the region. Advanced imaging tools provide detailed information about anatomy and function in the brain, leading to more accurate diagnosis, more effective treatment, and better patient outcomes. Sophisticated high-definition and 3-D imaging available 24/7 on-site includes:

• CT (computed tomography)
• CT perfusion/angiography
• MRI (magnetic resonance imaging)
• MR perfusion/angiography
• Neurovascular ultrasound
• Brain monitoring

Our physicians use the most advanced neuromonitoring techniques and image-guided endovascular therapies. For example, we use the latest mobile brain scanning technology, allowing critically ill patients to be imaged at the bedside.

Many minimally invasive, imaging-guided procedures facilitate the treatment of conditions that would have required surgery in the past. Examples include:

• Mechanical clot extraction devices, including Penumbra (Penumbra Inc.) and Solitaire (Covidien), to remove clots that block arteries in the brain and cause ischemic stroke.
• Coil and glue embolization to close off weakened arteries in brain aneurysms and congenital vascular malformations, reducing the risk of future hemorrhagic (bleeding) stroke.
• Angioplasty and stenting to open arteries in the neck and brain and enhance blood flow.
• Bedside ultrasound to image the brain and neck arteries and identify blood clots and other blockages. In other patients, ultrasound is used to diagnose increased brain pressure and to optimize the flow of blood to brain tissue.
• Minimally invasive monitoring to evaluate moment-to-moment heart filling and blood pressure.
• Minimally invasive brain monitoring to directly monitor and optimize pressure, temperature, blood flow, and chemistry in injured brain tissue — parameters that are critical for optimal treatment and for avoiding secondary injury to the brain.
• Continuous electrophysiological monitoring of brain activity to immediately detect clinically silent seizures as an early warning of secondary brain injury and as a tool to predict a patient's outcome.

Neurocritical Care

New York Presbyterian/ÈÕ±¾avÉ«ÇéƬ Medical Center has what is referred to as a "closed" neurocritical care unit, which means our attention is dedicated exclusively to the care of patients who have suffered from any type of acute brain injury, including severe and acute strokes.

Our dedicated neurocritical care team — certified specialists in vascular and neurocritical care — focuses exclusively on the special and complex needs of these critically ill patients. They provide moment-to-moment brain monitoring and interventions in a caring, highly specialized environment. The latest technologies, such as minimally invasive brain and cardiac monitoring, permit the early recognition and treatment of secondary brain injury from increased brain pressures or reduced blood flow.

Our critical care physicians are also available to provide second opinions regarding the care of critically ill patients at other hospitals, and to coordinate transfers when appropriate. They are experts in the management of all forms of brain and spinal cord injuries, and their extensive experience and expertise help us achieve the best possible outcomes.

Step-Down Unit

In 2010, NewYork-Presbyterian/ÈÕ±¾avÉ«ÇéƬ opened a 21-bed "step-down unit" to provide specialized care for patients with neurological illnesses such as stroke who are stable enough to leave the ICU, but who still require frequent neurological monitoring. All 21 beds are telemetry-monitored. Patients who need a ventilator, ventriculostomy, or lumbar drain can receive them on this unit. Our staff members take patients' vital signs every two hours around the clock, and there is 24-hour coverage by a member of the neurology team.

Rehabilitation

At NewYork-Presbyterian/ÈÕ±¾avÉ«ÇéƬ Medical Center, patients who have suffered from a stroke, another cerebrovascular emergency, or a brain or spinal cord injury begin rehabilitation as early as is safely permitted.

Comprehensive inpatient rehabilitation is available in the Inpatient Rehabilitation Medicine Center on the 17th floor of the Baker Pavilion. Our rehabilitation medicine physicians (physiatrists) direct an outstanding team of professionals that includes occupational therapists, physical therapists, rehabilitation nurses, social workers, speech-language pathologists, and recreation therapists. The unit helps prepare patients to return to their homes and communities. Outpatient rehabilitation is also available for patients requiring these services after leaving the hospital.

The type and success of rehabilitation depends on many variables, including:

• Nature and severity of the patient's neurologic disorder or injury
• Type and degree of any resulting impairments and disabilities
• Overall health of the patient
• Family support

We encourage families to be our care partners throughout the patient's recovery period. Social workers are also an important part of our team, supporting families with discussions about what to expect after the initial recovery period and where to obtain further rehabilitation, if needed.

Family-Centered Care

The input of patients and their families is critical to our ability to provide the best patient care on the Neurological Intensive Care Unit (Neuro-ICU) and throughout the hospital.

We consider the patient and his/her family to be an important part of our care team and encourage participation in decisions about treatment and in all phases of the recovery process.

Our neurocritical care team is spearheading a NewYork-Presbyterian-supported effort to establish family-centered care, allowing families to play an active role in decision-making about strategies to improve care on critical care units and throughout the hospital. Improvements that have already been made include the following:

• Visitation hours have been changed to 24/7 to better accommodate families and friends.
• After discussion with the family, children are allowed to visit their loved ones in the Neuro-ICU.
• Families are encouraged to join us in the morning for examination rounds.
• Treatment strategies and decision-making are closely discussed with family members, and regular updates are readily available from the care team.

This approach empowers families and patients to provide ideas on how to further improve patient care. Foreign language interpreters and educational materials are also available to enhance the understanding of families and patients about the care we are providing.

We believe that this kind of partnership among patients, family members, and caregivers speeds the healing process and results in better patient outcomes.