Welcome to the Yale Division of Neurocritical Care and Emergency Neurology. Here, you will find a multidisciplinary team dedicated to improving the lives of patients and families who have suffered from acute neurological injury. Our neurointensivists, neurosurgeons, nurses, and therapists work in the first and only dedicated neuroscience intensive care unit in Connecticut. Our team consists of international leaders in clinical care, research, and education. We are committed to bringing scientific advances to our patients and providing cutting-edge therapies in a compassionate environment. We encourage you to contact our team, should you wish to learn more about what we do.
Acute and critical disorders of the nervous system are common and crippling. Among others, they involve neurovascular diseases such as stroke and brain hemorrhage, trauma to the brain or spine, infection, or paralysis to all parts of the nervous system. Clinical research in our division takes many forms, including research on the biological basis for disease, epidemiology, neuroimaging, and clinical trials designed to provide cutting edge therapies to our patients. We also maintain an acute brain repository to collect biological samples on patients admitted to the neuroscience intensive care unit or the stroke service and long term outcomes for the patients we are privileged to care for. In addition to the funded studies listed, our faculty have recognized clinical research programs in prognosis formation, understanding coma, neuromonitoring, physiology, biomarker development, and the design of multicenter clinical studies. Our research interests our described in depth on each faculty member’s page.
|GAMES-RP (Remedy Pharmaceuticals)||National: Dr. Kevin Sheth Local: Dr. David Y. Hwang|
The purpose of this study is to assess the efficacy and safety of (RP-1127/Glyburide for Injection) compared to placebo in subjects with a severe ischemic stroke who are likely to develop severe brain edema. The goal of this project is to prevent brain swelling after stroke.
|POINT (NINDS)||Dr. Joseph Schindler|
The purpose of the trial is to determine whether clopidogrel (Plavix) is effective in preventing major ischemic stroke, myocardial infarction (heart attack), and death at 90 days.
|ATACH II (NINDS)||Dr. David Greer|
The purpose of this study is to find out if there is a benefit to reducing systolic blood pressure in a more intensive way compared with the standard systolic blood pressure treatment for patients admitted to the hospital for treatment of a hemorrhagic stroke.
|MISTIE III (NINDS)||Drs. Lauren Sansing and Charles Matouk|
This study is to determine if minimally invasive surgery (MIS) plus a drug to dissolve blood clots (rt-PA) is a safe and effective treatment compared to standard medical treatment for patients admitted to the hospital with brain bleeding.
|i-DEF in ICH (NINDS)||Dr. Kevin Sheth|
The purpose is to determine the efficacy and safety of the study drug, deferoxamine (which removes iron) compared to placebo in preventing secondary brain injury after brain hemorrhage.
|GENDCSS(NIH)||Dr. Kevin Sheth|
This is a genetic study for patients who have had a specific type of ischemic (clot) stroke. The study is specifically looking at DNA/genes to determine if there is a connection between certain genes and the formation of additional blood vessels in the brain known as collateral circutation.
|Understanding Priorities of Surrogate Decision Makers for Patients with ICH (American Brain Foundation)||Dr. David Y. Hwang|
The goal of this study is to determine whether segments of the general population can be classified with respect to their decision-making priorities when deciding on potentially instituting comfort care for a relative with a devastating intracerebral hemorrhage.
|Using Non-invasive EEG and Cerebral Oximetry Monitoring to Understand Brain Physiology in Critically Ill Patient with Sepsis (NIH)||Dr. Emily Gilmore|
The goal of this study is to use a novel approach that combines noninvasive multimodal real-time monitoring of brain activity (EEG) and cerebral oximetry monitoring to elucidate the relationship between sepsis associated brain dysfunction and cerebral perfusion.
|Understanding Potentially Harmful EEG Patterns in Patients with Acute Brain Injury and Critically Illness (AAN)||Dr. Emily Gilmore|
The goal of this proposal is to elucidate the relationship between commonly observed EEG patterns in critically ill patients, their response (both clinically and electrographically) to antiepileptic medications and their association with bona fide seizures and outcome.
The Yale Neuroscience Intensive Care Unit aims to provide the most sophisticated, empathic care possible to critically ill patients with nervous system injuries. Our goal is to bring together considerable breadth and depth in humanism and in science, across diverse areas of expertise, to be the premier neuroscience intensive care unit in the world. We constantly work towards this goal by adhering to the following values:
- Honesty, respect, support, and open communication from and amongst our multidisciplinary team
- Highest standards of patient safety and patient/family-centered care
- Compassion and kindness in all our interactions
- Environment which fosters the growth and development of our trainees so that they are ready to become tomorrow’s leaders in the clinical neurosciences
- Relentless pursuit of scientific advances that directly improve the lives of our patients
History and Description of the Neuro-ICU
There is a rich tradition of acute neuroscience at Yale University extending back an entire century. The initial chiefs of neurosurgery, Drs. Samuel Harvey and William German, were trainees of Harvey Cushing at the Peter Bent Brigham in Boston and Cushing himself joined Yale as the Sterling Professor of Neurology. Likewise, the neurology department’s founding chair, Gilbert Glaser, laid the foundation for a nationally unique program in epilepsy research and clinical practice, establishing Yale as a national home for NIH funded epilepsy grants. These early building blocks set the stage for a vibrant program in neurocritical care.
The Neuroscience Intensive Care Unit (NICU) at YNHH is one of the only dedicated certified neuroscience intensive care units in the state of Connecticut staffed by neuro-intensivists who are all board eligible or certified. Five attending faculty, with backgrounds from neurology and emergency medicine, make up the current cohort of clinical staff. The unit is a 14 bed neuro-ICU and has enjoyed multidisciplinary participation from a dedicated neuroscience pharmacist, active cadre of PA and NP’s, respiratory and physical therapists, a case manager, and residents from neurology and neurosurgery.
The Neuro ICU uses state of the art technology to facilitate the most advanced patient care. The ICU also maintains a portable CT scanner and has 24/7 access to an interventional neuro-angio suite which can also be used as a neurosurgical operating room with an intra-operative MRI. The neurocritical care division works closely with epilepsy, led by Dr. Larry Hirsch, an international leader in EEG practice and research in the neuroscience ICU. Nursing staff are nationally involved in the Neurocritical Care Society and regularly present at annual meetings.