Archive for the 'Neurology' Category

Advances in thrombolysis

Bill Likosky, MD, FAAN, FAHA, Director for Stroke and Telestroke, Swedish Neuroscience Institute

 

 

Washington State has one of the high­est stroke mortality rates in the nation. To improve this situation, acute intervention­al therapies for stroke are being employed to restore circulation to ischemic brain tissue that surrounds areas of completed infraction, while avoiding risk of hemor­rhage due to reperfusion of large areas of infracted brain tissue.

Urgent thrombolysis with intrave­nous alteplase is the only therapy known to improve clinical outcomes following acute stroke. Unfortunately, alteplase has had limited usage because many patients arrive in an emergency department after the three-hour treatment window. The FDA has also approved two clot removal devices based on the ability to restore circulation. These devices are used up to eight hours after symptom onset. Several approaches to improved acute stroke care are now under way, including extension of the thrombolysis window to 4.5 hours, identification of safer thrombolytic agents and research identifying brain at risk of in­farction following a stroke.

A recent European study demonstrat­ed the efficacy of alteplase up to 4.5 hours after ischemic stroke in patients younger than age 80 years who have neither dia­betes mellitus or prior stroke. The safety profile during this longer window for these patients appears similar to that at three hours.

Another promising advance employs a new thrombolytic agent called des­moteplase. Derived from the saliva of the vampire bat, this agent has a longer half life than alteplase and does not break down basement membranes, leading to a lower risk of hemorrhagic complica­tions. The Swedish Stroke Program is part of an international effort to test this drug in a nine-hour window.

Todd Czartoski, M.D., and Bart Keogh, M.D., Ph.D., are collaborat­ing with the stroke team at Stanford University to identify patients with vi­able ischemic tissue regardless of time from onset of symptoms. Perfusion MRI identifies impaired blood flow in brain (the “penumbra”) surrounding an infarct. In cases where there is a large area at risk, the use of alteplase or clot retrieval may prove beneficial long after the three-hour window has elapsed.

Telestroke is another important development in acute stroke care. This program enables the timely alteplase treatment of patients in emergency rooms around the Pacific Northwest that lack onsite neurological expertise.

For more information about the Swedish Stroke Program, contact Sherene Schlegel, R.N., FAHA, at 206-320-3484. For information about telestroke, contact Tammy Cress, R.N., MSN, at 206-320-3112.

Options widening for wide-necked aneurysms

 

Yince Loh, MD, Interventional Neuroradiology, Neurosurgery, Swedish Neuroscience Institute 

 

Intracranial aneurysms are present in up to 4 percent of the population. These potentially dangerous vascular lesions are being detected with increasing frequency in asymptomatic patients by advances in noninvasive imaging techniques, such as magnetic resonance angiography (MRA). Appearing like blisters on the wall of the brain’s blood vessels, aneurysms develop when the blood vessel’s native repair ability is exceeded by the mild, but constant, injury created by flowing blood under high pressure. The five most common risk factors for developing an aneurysm are: smoking, female gender, high blood pressure, middle age and family history.

Intracranial aneurysms are complex lesions that require a highly specialized, multidisciplinary approach that is individualized for each patient. Key members of the care team for these patients include endovascular neuroradiologists, neurosurgeons with special expertise in aneurysm surgery and neuroanesthesiologists. Availability of dedicated neurocritical care units is an essential care component. A consensus recommendation by these specialists may include close observation, obliteration of the aneurysm with a surgical clip, or filling the vascular outpouching with filamentous coils that are introduced by endovascular microcatheters via an artery in the leg. This latter process is called “coiling.”

Those aneurysms that have a balloon-like opening, or neck, from the parent vessel are typically good candidates for coiling. Not infrequently, however, the aneurysm’s shape does not permit safe coiling. When the aneurysm’s neck is wide, it appears more like a molehill than a balloon. A molehill configuration is often referred to as a “wide-necked aneurysm.” The wide neck allows an unwanted protrusion of coils back into the artery. This can lead to a number of problems, including failure to obliterate the aneurysm and stroke. Thus, in situations where an aneurysm is not surgically accessible or the patient cannot undergo surgery, no therapeutic options can be offered.

Until recently, wide-neck aneurysms could not be treated by coiling. The U.S. Food and Drug Administration, however, has approved a tubular device called an intracranial stent to be used for such situations.

Once a stent is deployed across the neck of the aneurysm, coils are placed into the aneurysm through the stent wall. The stent struts prevent the coils from falling back into the artery by essentially creating a “chain link fence” across the neck of the aneurysm.

Stenting, however, produces another set of problems. A stent is a foreign body that can promote the formation of a blood clot inside the vessel, which is why patients are placed on two antiplatelet medications to thin the blood, usually aspirin and clopidogrel (Plavix®), after placement of a stent. The length of time required to thin the blood after stent placement is unclear, although stents may become incorporated into the vessel wall and covered with endothelium within weeks.

Swedish Named a Leap Frog Top Hospital

The Leapfrog Group Announces Annual Top Hospitals List

The Leapfrog Group’s annual class of top hospitals – 65 from a field of nearly 1,200 – was announced today in Washington, D.C. and, for the first time, included Swedish Medical Center’s First Hill and Cherry Hill campuses. The announcement came at Leapfrog’s 10th anniversary meeting. A complete list of 2010 Leapfrog Top Hospitals can be viewed at www.leapfroggroup.org.

The Leapfrog Group is a coalition of public and private purchasers of employee health coverage – including Boeing and the Washington State Healthcare Authority – which was founded a decade ago to work for improvements in health-care safety, quality and affordability. Initially organized by the Business Roundtable, it is now an independent advocacy group working with a broad range of partners, including hospitals and insurers.

The ‘Top Hospital’ selection is based on the results of the Leapfrog Group’s national survey, which launched in 2001. It measures hospitals’ performance in crucial areas of patient safety and quality, including:

  • The use of computer physician order entry (CPOE) to prevent medication errors;
  • Standards for doing high-risk procedures such as heart surgery;
  • Protocols and policies to reduce medical errors and other safe practices recommended by the National Quality Forat um; and
  • Adequate nurse and physician staffing

The results of the survey are posted www.leapfroggroup.org.

Multiple Sclorosis Center, SNI

James Bowen, MD, Multiple Sclorosis Center, Swedish Neuroscience Institute

The Multiple Sclerosis Center continues to grow. We have added an additional MS nurse, Reiko Aramaki, RN. Reiko joined us from the Evergreen MS Center. She is certified by the International Order of MS Nurses and will expand our ability to respond to patient’s needs.

Outreach programs also continue. Dr. Bowen was recently interviewed by Kathi Goertzen from KOMO TV4 regarding CCSVI. This interview can be seen at http://www.komonews.com/home/video/106166123.html.

Also, Chaz Gilbert, a patient care coordinator won the Seattle Verizon Urban Challenge on 10/30/10, racing through 12 checkpoints in their city using only clues, their feet and public transit.

New center brings tertiary neurological care to children

 The Pediatric Epilepsy and Pediatric Neurology services at Swedish Medical Center have combined to create the new Swedish Pediatric Neuroscience Center. As part of the Swedish Neuroscience Institute (SNI), comprehensive neurological care for newborns, infants, children and adoles­cents is now located at the Swedish First Hill campus in Seattle. Marcio Sotero de Menezes, M.D., has been appointed direc­tor of the new center.

The center has a high patient volume for the medical and surgical treatment of seizure disorders, including complex epi­lepsy syndromes and genetic epilepsies. It is accredited by the National Association of Epilepsy Centers as a Level-4 epilepsy center.

In addition to epilepsy, the center’s specialists treat pediatric patients for a wide range of neurological disorders, in­cluding headache and migraine; move­ment disorders, tics and Tourette’s syn­drome; genetic and metabolic disorders; neurodevelopmental disorders and learn­ing disabilities; brain malformations; cere­bral palsy; stroke; tuberous sclerosis; and neurofibromatosis.

The center’s pa­tients will also benefit from a broad spectrum of pediatric neurol­ogy inpatient hospital services, including epilepsy monitoring unit, pediatric and neonatal intensive care units, procedural seda­tion services, pediatric neurosurgery and intraoperative EEG monitoring, imaging services, and neuropsychological testing. Physical, occupational and speech therapy services are also available to the center’s patients.

For more information about the Swedish Pediatric Neuroscience Center, please call 206-215-1440. 

  

Marcio Sotero de Menezes, MD, Pediatric Epilepsy, Pediatric Neurology, Swedish Neuroscience Institute

Clinical Neurophysiology Lab Receives Accreditation

Congratulations are in order for the Clinical Neurophysiology Laboratory for attaining Accreditation by the EEG Laboratory Accreditation board of ABRET.  We are the first and only Lab to receive Accreditation in Washington State and one of only 10 labs west of the Mississippi. 

Accreditation means the Lab has met strict standards and is recognized as a place where patients and physicians can have confidence they are receiving quality diagnostics.

 Thanks for all the great work and CONGRATULATIONS to everyone on the team who made this possible!

-Colleen Douville
Director for Cerebrovascular Ultrasound
Program Manager for Clinical Neurophysiology

The neurophysiology laboratory at Swedish is a critical component to the Epilepsy program.

Staying Fit to Prevent Stroke

William H Likosky, MD, Neurology
Medical Director for Stroke and Telestroke

 

A brisk walk for as little as 30 minutes a day can improve your health in many ways and may reduce your risk for stroke. Join our Stroke Program’s medical director, William Likosky, M.D., and one of our exercise physiologists to learn how to stay fit and reduce your risk for stroke. Free blood pressure screening will also be available.

Cherry Hill – Pinard Foyer

Tuesday, Oct. 12, 11 a.m.-1 p.m

For more information, please contact Sherene Schlegel:

sherene.schlegel@swedish.org

Office: 206-320-3484