Division of Stroke and Critical Care, Neurology, New York

» Stroke Prevention
» Treating the Whole Patient

Stroke — Brain Attack
TIAs — Critical Warning Symptoms and Types
Aneurysms — Bulging Blood Vessels That Can Rupture
AVMs — Arteriovenous Malformations

» Innovation in Diagnosis and Treatment

Endovascular Therapies
AVM/Aneurysm Leadership
Raising the Bar

» World Class Professionals

Stroke Prevention

A simple ultrasound scan can quickly and easily tell if you have severe carotid disease. If you have a little bit of plaque the goal is to prevent it from becoming worse! A Patient's Guide to Carotid Ultrasound

Treating the Whole Patient

People come to us by many routes, but always in immediate or imminent crisis. The brain, and the cerebrovascular system that supports it, are critical to our function and identity— walking, talking, seeing, hearing, thinking and knowing ourselves and others. But whether you arrive by ambulance to the emergency room, by visiting one of our physician’s offices, or by referral from across town, across the nation, or across the ocean, you’re in good hands.

The Columbia Stroke and Critical Care Centers have a world-class team of neurologists, neurosurgeons, interventional neuroradiologists, neurointensivists, neuroanesthesiologists, neuropsychologists, and rehabilitation specialists who work collaboratively to resolve crises and save lives. Our team reviews your case and develops a plan tailored to your personal situation — so each patient receives exactly what is needed to diagnose, prevent, and treat stroke and other cerebrovascular diseases.

The Centers combine the medical leadership and clinical excellence of two of the oldest and most renowned leaders in cutting-edge research and patient care — Columbia Presbyterian Medical Center and New York Weill Cornell Medical Center. We are uniquely qualified to offer you outstanding health services in an atmosphere of compassion, caring, and clinical excellence.

Stroke

is the third-leading cause of death in the U.S. and other Western countries — and the second most common cause of disability Strokes are usually caused by a clot blocking the blood supply in or to the brain. Perhaps you feel a sudden numbness in your face, an arm or leg, especially on just one side of your body. Or you have sudden difficulty walking, speaking, understanding, or seeing with one or both eyes. Or you’re suddenly hit by confusion, dizziness, or loss of balance or coordination.

Come to us quickly! Our emergency room reams are trained to provide the extraordinarily rapid response essential to prevent disability or death. Fast evaluation and admission to the stroke service can enable administration of dot-busting Tissue Plasminogen Activator (TPA) medication — the key to successful outcomes. But it must be given within three to six hours of the onset of symptoms.

TIAs

ischemic attacks (TIAs) are critical warning signs that a stroke may be on the way — tomorrow, next month, next year. The symptoms may be the same as a stroke, yet milder and temporary, lasting only a few minutes. Some experts call TIAs mini-strokes. Somewhere in the network of blood vessels supplying the brain, there’s a narrowing of one or more blood vessels. Perhaps a spasm has occurred. When it passes, the symptoms go away. But they cannot be ignored — because they will return and escalate. Our experts work to find the source of the problem — and fix it.

Aneurysms

are bulges in blood vessels caused by stretching and thinning of the vessel wall. Ruptured cerebral aneurysms — those that burst and bleed — are quite serious and may lead to swelling in the brain, narrowing of blood vessels, or stroke. Historically, about 20% of its victims have been disabled and 60% die. To prevent such disasters, ruptured aneurysms need immediate repair. Ideally; unruptured aneurysms, which may cause headache, weakness, numbness, vision change, or pain behind the eye, should be repaired before a crisis occurs.

Arteriovenous Malformations

(AVMs) are short circuits — abnormal connections — between arteries and veins. Capillary beds, the fine network of tiny vessels where blood nourishes tissues, are missing. In the brain and spine, AVMs may cause seizures or persistent headaches or lead to progressive neurological problems. Or the blood vessels may weaken and rupture. causing the less common type of stroke (hemorrhagic), those that, unfortunately, are even more likely to be fatal.

Innovations in Diagnosis and Treatment

Whatever the crisis, the staff of our Stroke and Cerebrovascular Disease Center creates a continuum of care — from the moment a patient arrives — to minimize damage and give you the best chance of survival and recovery of quality of life and function.

After a devastating cerebrovascular event, outcome may totally depend on the resources, monitoring and action in the first 24 to 72 hours. That’s why many families request transfer to our New York-Presbyterian Hospital and its Neurological Intensive Care Units (NICU) - the only multi-disciplinary, academic, neurocritical care facilities in the greater New York area. We are national leaders in research devoted to developing advanced treatments for life-threatening neurological diseases. We offer the most sophisticated diagnostic technologies in neuroscience. Carotid angiography and CT scans have been the traditional approaches to spot AVMs and aneurysms within the brain. Now, imagingmodalities such as SPECT, PET, or MRI provide more detailed information on the brain’s functional status. Interventional neuroradiologists combine such information with data obtained by making direct measurements of blood vessel behavior during endovascular approaches to direct clinical treatment.

Our Cerebrovascular Disease Centers are among the few sites in the world to offer superselective Wada testing, a diagnostic technique for precisely mapping areas of the brain responsible for language, vision, memory thinking, movement, and other functions. This test helps identify the safest means of treating AVMs. The use of this test has resulted in a significantly lower rate of complications following endovascular treatment of AVMs compared to other institutions.

Endovascular Therapies

involve inserting a thin, flexible catheter into a leg artery and, under x-ray guidance, moving it through the body to the area to be treated. With the catheter in place, neuroradiologists can conduct the most advanced methods of treating AVMs, aneurysms and other conditions that may cause — or have caused — a stroke or neurologic damage.

First, a test medication may be injected to confirm the location and expected outcome of the procedure — so that the benefits and risks can be assessed before proceeding. Then materials may be inserted into the blood vessels to open or close diseased vessels or to deliver medicine to specific areas.

For example, our stroke specialist team administers TPA intravenously, or by this innovative new endovascular approach, which enables application of TPA directly to the site of the clot. When clinically indicated, this more focused treatment improves the efficacy of TPA all the way to the end of its six-hour window. For TIAs, an endovascular approach enables balloon angioplasty to open the vessel and, if appropriate, inserting a stent — a metal scaffolding — to hold it open.

AVM/Aneurysm Treatment

The Neurological Institute at Columbia University Medical Center is a global leaders in the treatment of AVMs and aneurysms. Repair may be accomplished with any or all of the following advanced therapies:

endovascular embolization to plug the problem blood vessels with “super glue” or to insert tiny platinum coils to prevent bleeding;
high-dose radiosurgery using our 3-D state-of-the-art Gamma Knife or our X-Knife, that allows some patients to return home within hours;
surgery to place a clip over the aneurysm to prevent it from growing or rupturing;
hypothermia arrest surgery placing the patient on cardiac bypass, lowering body temperature, and removing the blood temporarily — to eliminate the risk of giant aneurysm rupture during the procedure;
functional MRI for brain mapping; and
microsurgery with cerebral protectants to eliminate collateral injury daring removal.

Raising the Bar

“The specialized program on translational research in acute stroke, which unifies investigators in the pursuit of novel approaches to treating acute stroke.”
“The Northern Manhattan Family Study (NOMAFS), which focuses on detecting new genes in predicting stroke risk.”

Because Columbia Weill Cornell is a distinguished, preeminent center for neuroscience clinical trials, including work supported by the National Institutes of Health, you have access to the latest diagnostic and treatment approaches in development. Our exceptional resources enable our medical scientists, physicians, and surgeons to lead the search for new ways to prevent and treat strokes and cerebrovascular disease. These studies include:

The Carotid Endarterectomy and Stenting Trial (CREST), which is comparing the two methods;
The Columbia Center AVM Study, using our database to assess natural history and treatment outcomes;
The New York Islands AVM Study, evaluating the incidence of hemorrhage, its consequences, and the efficacy of various treatments;
The World AVM Study; which will establish a global AVM database to help create an international standard for diagnosis and treatment;
The Northern Manhattan Stroke Study (NOMASS), which focuses on stroke prevention and risk facto detection — one of the first comparative studies among Caucasians, African- Americans and Hispanics living in the same community and
Weill Cornell Incidental Aneurysm Database, being used to assess natural history and treatment out cozies.

World Class Professionals

Cerebrovascular disease can affect anyone — and we at the Neurological Institute at Columbia University Medical Center believe that everyone is entitled to the finest treatment possible. The extraordinary breadth of our capabilities allows us to deliver a quality of care that can truly make a difference in patients’ lives.

Consistently ranked among the top five providers of neuroscience services in the nation, the the Neurological Institute at Columbia University Medical Center offers the most innovative, up-to-date treatments to combat the full range of neurological disorders. Our dedicated team of healthcare professionals works together as a unified, patient-centered system to meet the needs of people with diverse and complex problems.

New York-Presbyterian Hospital is ranked higher in more specialties than any other hospital in the New York area by US. News & World Report. Whether it’s you, your child, your spouse or your parent, you can feel confident that no other hospital in the New York area will provide better care. You’re in good hands.