The Division of Vascular Neurology evaluates, treats and studies diseases which affect the structure and function of the blood vessels supplying the brain. Our main purpose is to provide the best possible care for our patients with stroke cerebrovascular disease.
The academic mission is two-fold: (1) to represent the principal educators of cerebrovascular disease for the Yale School of Medicine, the Yale Neurology Residency Program, and practitioners throughout New England; and (2) to investigate novel translational approaches to more effective acute stroke treatments, better secondary stroke prevention strategies and to improve stroke recovery and rehabilitation.
Vascular Neurologists hold teaching appointments at the Yale University School of Medicine and are clinical faculty within Yale Medical Group. They provide outpatient consultations in a multidisciplinary setting at the Yale Physician's Building or at the VAMC in West Haven, CT. Consultative services are also provided at Gaylord Hospital, one of the major rehabilitation hospitals in Connecticut. Yale conducts numerous acute and secondary stroke prevention clinical research trials including those sponsored by industry and the National Institutes of Health.
The stroke program was certified as a Primary Stroke Center by the Joint Commission in 2005 and by the Connecticut Department of Public Health in 2008. Its mission is to provide safe, effective, patient-centered, timely efficient and equitable care to patients with cerebrovascular disease at Yale-New Haven Hospital. The Stroke Center serves as a primary referral center for acute stroke management and has multidisciplinary outpatient stroke clinics for secondary stroke prevention and stroke recovery.
Joseph Schindler, MD serves as the Clinical Director of the Yale-New Haven Stroke Center and leads the acute stroke team activities. The hospital's resident-staffed acute stroke team is available 24/7 and in collaboration with clinical staff from neurosurgery, neuroradiology and emergency medicine, provide acute stroke consultation, treatment and cutting-edge interventional treatment aided by state-of-the-art imaging.
Yale-New Haven Hospital is the only hospital in Connecticut to offer acute vascular neurology consultation through the Yale-New Haven Telestroke Network. Now in its fourth year of operation, the Network allows a team of neurologists to provide 24/7 telemedicine coverage to two outlying hospitals in Connecticut and work in collaboration with the clinical staff in the Emergency Department to evaluate and treat patients presenting with acute neurological emergencies. These patients are also offered the opportunity to be transferred to Yale-New Haven Hospital for Neuro-interventional procedures, monitoring in the Neuro-Intensive Care Unit and enrollment in clinical trials.
What is a Stroke?
A stroke, sometimes known as a “brain attack,” occurs when blood flow to the brain is disrupted or cut off. This leads to damage or loss of function of that part of the brain. Loss of blood flow can occur when a blood clot or cholesterol plaque blocks off a blood vessel (also known as an ischemic stroke), or when a blood vessel ruptures causing bleeding into the brain (also known as a hemorrhagic stroke). A hemorrhagic stroke can be cause by hypertension, aneurysms or abnormal blood vessel formations. In the United States, approximately 800,000 strokes occur each year (or one every 40 seconds). It is the fifth leading cause of death in the United States, and a major cause of permanent disability. Symptoms from a stroke can vary depending on the location of the stroke in the brain. The most common signs and symptoms of stroke are:
- Weakness (drooping) or numbness of the face on one side
- Weakness or numbness of an arm and/or leg on one side of your body
- Sudden dimming or loss of vision in one or both eyes
- Difficulty speaking or understanding what others may be saying
- Sudden, severe headache
- Severe dizziness, loss of balance or coordination
If you notice any of these symptoms, it is important to call 911 and get to an ER immediately!
What is a TIA?
A TIA, or Transient Ischemic Attack, is like a stroke but does not cause permanent brain injury. It is sometimes called a “mini stroke.”
The symptoms are the same as a stroke, but resolve within a few minutes or hours. The underlying causes are the same as a stroke. Therefore if you are diagnosed with a TIA, you will still receive the same treatment and testing that a patient who had a stroke would. Our doctors will provide a thorough evaluation to find the source of your TIA.
There is no definitive test for a TIA, as your brain imaging will not show a stroke. The diagnosis is strictly based your symptoms, and the fact that they resolved. Patients with TIA’s, however, are at higher risk for stroke in the very near future! You must not ignore the symptoms. It is important that you see a doctor to minimize your risk of having a future stroke.
Risk Factors of Stroke
Risk factors are medical conditions or behaviors that increase your chances of having a stroke. Some are treatable, others are not. Treatable risk factors include:
- Atrial Fibrillation
- High Cholesterol
- Significant alcohol use
- Heart disease
- Use of certain medications (i.e. oral contraceptives, testosterone)
Untreatable Risk Factors:
- Age (>65)
- Gender (Males are at higher risk)
- Race (African Americans are at higher risk compared to other races)
- Family History
Treatment for Stroke
Treatment for stroke depends on the type of stroke you have, and your risk factors. It is critical to bring yourself to a hospital immediately if you are experiencing stroke like symptoms, because your hospital may be able to treat your stroke in the emergency room.
Treatment for Acute Stroke:
- TPA: the only FDA approved medication for acute ischemic stroke. TPA is a clot busting medication that must be given within three hours from symptom onset. In certain situations that time frame may be extended.
- Endovascular treatment: Catheter-based interventions for clot busting or clot extraction. Patients eligible for these interventions must meet strict criteria that your doctor will review with you or your family.
Medications for Stroke Prevention:
- Anti-platelet agents: Aspirin, Clopidogrel (Plavix®), Aspirin/Extended-Release Dipyridamole (Aggrenox®)
- Warfarin (Coumadin®), Eliquis, Pradaxa and Dabigatran
- Statins: lower cholesterol
Surgical Treatments for Stroke Prevention:
- Carotid Endarterectomy: A carotid endarterectomy is a procedure by which atherosclerotic plaque is surgically removed from a carotid artery that is narrowed. Ask your doctor if you meet criteria for an endarterectomy.
Treatment for Hemorrhagic Stroke:
- Medications to lower blood pressure
- Medications to control swelling and damage caused by the swelling
- Your doctor may tell you to avoid medications that would thin out your blood
- Further testing to identify the cause of your bleeding will dictate future treatment
What Can I Do To Lower My Risk of Stroke?
If you have high blood pressure, check it frequently to make sure it is within a normal range. Avoid missing or skipping doses of your medications, and eat a low salt diet.
- Stop smoking
- Check your cholesterol
- If you have diabetes, monitor your blood sugars carefully. Avoid missing or skipping doses of your medications, and stick to a healthy diet recommended by your doctor
- Get regular exercise and maintain a healthy weight
- Eat a diet rich in fruits, vegetables, low fat dairy products, nuts, fish and lean meats
- Limit your alcohol intake. For men, do not drink more than 2 drinks a day. For women, do not drink more than 1 drink a day
- Avoid illegal drugs
Recovering from a stroke varies from patient to patient. The ultimate goal is to return a patient to independent living. Success will depend on a variety of factors, such as severity of symptoms, whether the patient received TPA, age, other medical conditions, family support, and patient motivation. Patients with weakness or paralysis of an arm or/or leg may have problems holding objects, performing tasks with hands, walking or maintaining balance. Intense physical and occupational therapy is useful in regaining these functions. Patients with difficulty forming words or sentences, or inability to understand others, will require an evaluation by a speech and language therapist. Patients with difficulty swallowing or eating are at higher risk of acquiring lung infections (pneumonia). They will require evaluation by a speech and swallow professional. Patients with post-stroke depression may require counseling or medication. Studies have shown that aggressive treatment of depression can improve recovery following stroke, so it is important to let your doctor know if you or your loved one are suffering from depression symptoms.
In 2008, Yale-New Haven Stroke Center established Connecticut's first telemedicine — or telestroke program. Under the leadership of Joseph Schindler, MD, neurologists use a video and image-sharing telecommunications system to provide acute stroke care consultative services to outlying hospitals when patients present with acute stroke symptoms. Within minutes of making an initial call to Yale's telestroke network, the on-call neurologist can examine a patient at the remote hospital to help diagnose and make recommendations for treatment. This service offers selected patients the opportunity for treatment with IV tPA and for transfer to YNHH for neuro-interventional procedures.
YNHH has partnered with Lawrence and Memorial Hospital (New London, CT), Sharon Hospital (Sharon, CT) and Griffin Hospital (Derby, CT) to deliver acute stroke consultative services on a 24/7 basis. In addition, monthly teleconferencing meetings are held to review cases and to stay updated on the latest research and evidence-based guidelines for acute stroke care. Hospitals within the telestroke network are certified as Primary Stroke Centers by either the CT Department of Health and/or the Joint Commission.
Telestroke programs throughout the country have demonstrated that telemedicine conferencing between outlying hospitals and trained stroke neurologists can enhance the use of tPA at hospitals that do not have on-site neurologists 24/7. Data analyzed from services rendered to our remote hospital showed a 90% increase in the rate of IV tPA administration and a reduction in the rate of symptomatic hemorrhage when comparing services pre and post telestroke (International Stroke Conference 2011).
Telestroke impact on patient care
A Stroke Story: David Schrage, a physically fit, 51-year-old tri-athlete, suffered a devastating stroke one afternoon at the office. Through video communication, drug therapy and cutting-edge neurosurgery at Yale-New Haven Hospital, Schrage was on the road to recovery within days (click to watch video).
The following clinical trials related to stroke at Yale-New Haven Hospital are currently undergoing relating to stroke at Yale-New Have Hospital. If you are interested in participating in any of these trials, please follow the links below. For ALIAS2 and CLEAR III, the patient must either be in the Emergency Room or admitted to the hospital with a new stroke.
- IRIS: Insulin Resistance Intervention After Stroke Trial
- ALIAS2: A Phase III Randomized Multicenter Clinical Trial of High-Dose Human Albumin Therapy for Neuroprotection in Acute Ischemic Stroke - Part 2 (HIC: 0701002162)
- CLEAR III: Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (HIC: 0910005903)
For more information please contact the Clinical Research Nurse Coordinator at the Yale-New Haven Stroke Center; email Janet Halliday, RN or call 203-737-1057.
The Stroke Clinic allows patients access to world-class expertise in stroke management and prevention. Faculty and staff in the Vascular Neurology Division have daily clinics at Yale Physicians Building. In addition to providing cutting-edge treatments we also offer our patients opportunities to be involved in ongoing clinical trials. To make an appointment or referral please call 203-737-1057.