What is Vascular Neurology?

Vascular Neurologists are Also Called 'Stroke Doctors'

Vascular Neurologist at Work. John Foxx/Getty Images

Vascular neurology is the treatment of strokes. A stroke is a disease that affects the blood vessel that lead to the brain and the blood vessels that travel within the brain. A stroke is characterized by certain symptoms, such as weakness, numbness, vision changes and speech disturbance.

A stroke occurs when an artery carrying oxygen and nutrients to the brain is either blocked by a blood clot (ischemic stroke) or bursts (hemorrhagic stroke.) When this occurs, the part of the brain that relies on blood supply from the interrupted blood vessel cannot get adequate blood (which contains oxygen and nutrients.) And when blood supply is inadequate, that is when the stroke symptoms begin.

Most of the time, a doctor, a nurse or another health care professional can diagnose a stroke. Usually, stroke treatment is started right away, and sometimes, stroke treatment can even begin in the ambulance on the way to the hospital. There are usually many people who are part of the stroke care team. Typically, a neurologist is involved in the more complex details of stroke diagnosis and stroke treatment.

Sometimes, in particularly complicated situations, a vascular neurologist is consulted to direct stroke diagnosis and treatment, and may follow up with you throughout your recovery. A vascular neurologist is a neurologist who also has additional training and expertise in stroke care, treatment and prevention. 

Types of Stroke

There are two types of strokes: hemorrhagic or ischemic. The treatment differs depending on the type of stroke.

During an ischemic stroke, a blood vessel supplying blood to the brain becomes blocked.

During a hemorrhagic stroke, a weakened blood vessel ruptures and spills blood into brain tissue. There are two other types of weakened blood vessels that also cause hemorrhagic stroke: brain aneurysms (a swollen section of an artery that can tear) and arteriovenous malformations (AVMs).

Just a few years ago, there was little that doctors could do to treat strokes, due to the lack of diagnostic techniques and effective treatments.

However, over the past few decades, neurologists and other physicians have developed multiple new and effective approaches to diagnose, treat and prevent strokes, resulting in substantially improved stroke care.

Ischemic Stroke Treatment

There are several treatments for ischemic stroke. One of these is tissue plasminogen activator (tPA) which is given intravenously (in the arm). Proper administration of tPA dissolves the blood clot and improves blood flow to the brain, potentially preventing long term stroke damage and disability. 

Another treatment option is an endovascular procedure called mechanical thrombectomy, which attempts to remove a large blood clot by sending a wired-caged device (called a stent retriever), to the site of the blocked blood vessel in the brain.

Hemorrhagic Stroke Treatment

Endovascular procedures may be used to treat certain hemorrhagic strokes similar to the way the procedure is used for treating an ischemic stroke. During these procedures, a catheter is inserted through a major artery in the leg or arm, then guided to the aneurysm; it then places a coil to prevent rupture.

Surgery can also help stop the bleeding. If the bleed is caused by a ruptured aneurysm, a metal clip may be placed surgically at the base of the aneurysm to secure it.

Vascular Neurologists

Vascular neurologists are also often called 'stroke doctors.' To become proficient in these approaches to stroke treatment, physicians must acquire a great deal of experience and training. All neurologists have a great deal of experience in managing strokes. Vascular neurology is an additional subspecialty after completion of neurology training that allows neurologists to receive additional training in the latest techniques in stroke care.

If you have had a stroke of unexplained cause, medically referred to as a cryptogenic stroke, you might be referred to a vascular neurologist for further diagnosis.

Similarly, if you have a particularly high risk situation, such as a stroke during pregnancy, or a blood disorder that could lead to a stroke, you might need to see a vascular neurologist.

Because there are not many vascular neurologists, you might need to go to a hospital or a medical center located further from your home for your vascular neurology consultation and then continue your care in a more convenient location closer to your home.

References:

Stroke physician versus stroke neurologist: can anyone thrombolyse? Lee A, Gaekwad A, Bronca M, Cheruvu L, Davies O, Whitehead C, Agzarian M, Chen C., Intern Med J. 2015 Mar;45(3):305-9

Edited by Heidi Moawad MD

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