Stroke Program Director Patrick Lyden, MD, front right, who also chairs the Department of Neurology, discusses complex neurovascular cases with residents, fellows, faculty and clinical experts during the weekly Neurovascular Conference.
'Code Brain' Response
The Code Brain system at Cedars-Sinai is activated when there is concern for an acute stroke with the potential for hyperacute therapies or enrollment into clinical trials. An average of zero to 15 such calls are generated per week, and vascular neurology fellows join rotating neurology residents as first responders to these neurologic emergencies. Fellows gain extensive experience in selecting patients for tissue plasminogen activator (tPA) and endovascular treatment, as well as intracranial hemorrhage and subarachnoid hemorrhage management.
Fellows cover the Code Brain system every other week, with assistance from the experienced stroke team nurses who help with both patient triage as well acute stroke management. They also assist other inpatient services by providing vascular neurology consultations.
Stroke Program Clinic Days
When not covering Code Brain, fellows will participate in two half days of stroke clinic per week, supervised by Vascular Neurology faculty.
- Neurovascular Conference
At noon each Wednesday, fellows have the chance to discuss diverse and complex cases with experts from neuroradiology, neurosurgery, neurointerventional, and vascular surgery trainees and faculty.
- Code Brain Conference
On a weekly basis, fellows review all Code Brain cases for both didactic and quality assurance purposes.
- Stroke Journal Club
On a monthly basis, new studies relevant to cerebrovascular diseases are reviewed, keeping fellows current with the evolving landscape of stroke medicine.
- Core Literature Review
Stroke fellows and rotating residents meet on a weekly basis to discuss a landmark article relevant to vascular neurology, ensuring proficiency in the application of evidence-based medicine to clinical practice.
Clinical Trials and Research
In addition to seeing patients, fellows are trained in clinical investigation to develop organizational and trial development skills. Fellows become coinvestigators on active stroke clinical trials, and assist in patient recruitment and study conduct.
In addition, fellows participate in and lead other research projects and submit abstracts for presentation at conferences, including the annual International Stroke Conference.
Interested trainees may also pursue the option of an additional year of fellowship training in order to concentrate on research pursuits.
Transcranial Doppler (TCD) Ultrasound Proficiency
TCD studies using both duplex transcranial imaging and M-mode Doppler scanning are regularly performed and interpreted by the stroke team.
All fellows are expected to become competent TCD readers. We provide an opportunity to attend the annual American Society of Neuroimaging meeting, at which time fellows may take the certification exam in neurosonology.
Fellows may also pursue additional exposure to related subspecialties, including neuroradiology, endovascular neurosurgery, neurorehabilitation and neurocritical care through available electives.