The primary focus of our stroke fellows is the acute assessment and subsequent management of stroke patients in the emergency departments of our regional hospitals.

Since 1988, we have been on call 24-hour a day, seven days a week for the Greater Cincinnati/Northern Kentucky region. We currently average approximately 10 telephone calls for potential stroke calls per day (5,000 calls per year).

Approximately one quarter of these calls require that the stroke physician go to the hospital to evaluate the patient in person or log into telemedicine to view the patient.

Currently, physicians who are on-call for the Acute Stroke Intervention Team include seven stroke neurologists, 1-3 vascular neurology stroke fellow(s), seven emergency physicians, four neuro-ICU fellows and three neuro-interventionalists (one vascular neurologist, one neuroradiologist and one endovascular neurosurgeon).

We average approximately 500 patients per year who are treated with thrombolytic medication within three hours of stroke onset at our 25+ regional hospitals that we serve via telemedicine.

For the first two months, the fellows are not entered into the stroke call pool. They accompany the stroke attending on-call for all prospective cases during the day (except if otherwise in outpatient clinic) and are on-call two nights a week as well. They are also welcome and often attend stroke calls outside of their scheduled call times. They are responsible for evaluation of the patient and subsequent follow-up for the next 24 hours.  Patient logs are kept by the fellow for review with the program director.

At UC Medical Center, the stroke fellow will follow and be responsible for the care of the stroke patient working with the University Hospital Neurology service. At the other regional hospitals care of the stroke patient is transferred to the local neurologist or internist the following day with additional input offered as needed. 

All fellows obtain clinical privileges at the regional hospitals that are part of their training experience. Each fellow is provided with a cellphone stipend to interact with the hospitals and to answer pages at any time.  The fellow is also provided a tablet device by UCMC, which can be used for telemedicine

The fellows are gradually given increasing responsibility to answer pages (to determine eligibility for tPA), evaluate the acute stroke patient and make clinical decisions regarding tPA use. The expectation is that they primarily observe at first but become independent stroke clinicians by the end of the two-month period. Thereafter, they are entered into the call pool and function independently in all aspects of acute stroke care.

The attendings that are not on-call are still available by page or phone at all times to assist the fellow with questions or concerns regarding difficult cases. The stroke faculty interacts directly with the stroke fellows on all stroke patients.

The stroke fellow is expected to manage all of the critically ill patients they have treated with tPA or other acute therapies for the first 24 hours at the regional hospitals, and the entire hospitalization at UC Medical Center. This will involve critical care management of acute stroke including blood pressure control, increased intracranial pressure/cerebral edema, intracranial hemorrhage and, occasionally, central line placement and ventilator management. 

Additional experience in critical care and neurosurgical diseases such as aneurysm/AVM management is required for an additional one month in our neuro-ICU, where the fellow will be an integral part of the NSICU team managing these critically ill patients..

Also, for at least one to two months out of the year, the fellow will round daily on all the stroke patients admitted to the inpatient neurology service. On average, this will range from one to five patients per day. The fellow will take primary responsibility for decision-making regarding these patients, with backup from the attending. Fellows will be expected to teach residents and students at the bedside as well.

Specific training regarding neurological and medical complications after stroke will be taught through bedside teaching and didactic lectures by the stroke faculty.

Fellows are expected to order and interpret all appropriate imaging studies, and will receive training in this regard from the stroke and neuro-radiology faculty members of the stroke team. 

The neurology stroke fellow will also see stroke patients as outpatients in one of three locations. They will see new and complex cerebrovascular cases as well as patients who are evaluated as part of ongoing clinical research protocols. These clinics include:

• General Stroke Clinic: This is usually for stroke patients recently discharged from UC Medical Center. Many of the prevention studies screen in this clinic. This clinic is staffed on a rotating basis with each of the seven stroke neurologists.
• Multi-Disciplinary Neuro-Intervention Clinic: Held in the neurosurgery department, these patients have all been referred for intervention, including intracranial aneurysms, AVMs, carotid stenosis etc. Dawn Kleindorfer, MD is the neurologist, and Charles Prestigiacomo, MD is the neurosurgeon. All patients are seen by both disciplines; neurology’s role is to assess medical management.
• Stroke Recovery Clinic: Staffed by Oluwole Awosika, MD and Elisheva Coleman, MD, this interdisciplinary clinic provides functional impairment assessments and customized care planning for chronic stroke survivors. The clinic also serves as a bridge to connect stroke survivors to the wealth of cutting-edge translational research and clinical trial opportunities available at the University of Cincinnati and the surrounding region.

1:30–3:30 p.m.: Graduate level course work.

8–9 a.m.: Weekly clinical research conference. Acute stroke cases that are part of clinical trials are presented and discussed. Bi-monthly presentation by one of basic scientists on ongoing research for discussion and critique.

9–10 a.m.: Weekly clinical research conference dealing with all ongoing epidemiologic and genetic studies.

11 a.m.–Noon: Work on ongoing clinical research projects.

1–5 p.m.: Young Adult Stroke Clinic at Cincinnati Children’s Hospital Medical Center - Monthly

7:30–8 a.m.: Journal Club for Neurology Residents – Stroke fellows participate in articles related to cerebrovascular disease.

7:30–8 a.m.: Journal Club for Neurology Residents – Stroke fellows participate in articles related to cerebrovascular disease.

8–9 a.m.: Neurology Grand Rounds.

9 a.m.–1 p.m.: Work on ongoing clinical research projects or master’s level course work depending on quarter.

1:30–3:30 p.m.: Graduate level coursework.

7:30–8:30 a.m.: Interdisciplinary neurovascular radiology conference with stroke physicians and nurses, vascular neurosurgery, endovascular neuroradiology. Review of cases from previous week.

7:30–8:30 a.m.: Interdisciplinary neurovascular radiology conference with stroke physicians and nurses, vascular neurosurgery, endovascular neuroradiology. Review of cases from previous week.

9 a.m.–5 p.m.: Work on ongoing clinical research.

7:30–8:30 a.m.: Neurology faculty meeting once per month.

Noon–1 p.m.: Didactic lecture series, fellows to attend stroke-related topics.

8 a.m.–Noon: Neuro-intervention Clinic (.monthly

1–5 p.m.: Stroke Clinic (every other week).