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Stroke Fellowship OverviewThe Wayne State University (WSU) Stroke Center offers several one or two year fellowships in cerebrovascular disease, neurological critical care, or combined cerebrovascular disease-neurological critical care. The fellowship consists of structured research activities (independent mentoring of research projects and training combined with formal curriculum as well as active participation in ongoing acute and preventive clinical trials and epidemiological studies), clinical duties, and training in neurosonology (transcranial and carotid Doppler ultrasound) and state-of-the-art neuroradiology diagnostic procedures including diffusion and perfusion magnetic resonance imaging. Opportunities for further training in interventional neuroradiological procedures such as intra-arterial thrombolysis, cerebral arterial angioplasty and stenting are available following completion of the stroke fellowship. The Stroke Team physicians include 3 attendings trained in cerebrovascular disease (Dr. Steven R. Levine, Dr. Seemant Chaturvedi, and Dr. Bradley S. Jacobs) and 2 attendings trained in neurological critical care and cerebrovascular disease (Dr. William Coplin, Dr. Mark Gorman). Several clinical study nurse-coordinators, study staff, a full-time stroke educator, and research volunteers are involved with the multiple research studies. Research opportunitiesResearch opportunities involve participation in several acute stroke treatment and secondary stroke prevention trials. Research in association with other ongoing clinical studies as well as independent research with formal and regular guidance and structure from faculty is provided. Current ongoing research projects include studies of antiphospholipid antibodies and stroke (APASS) (NIH funded), telemedicine for stroke ("telestroke"), stroke risk assessment and prevention ("STRAP") (funded by the State of Michigan Department of Community Health), stroke in African Americans (NIH funded), and carotid angioplasty and stenting. Opportunity exists to become actively involved in state and local stroke-related activities including the Michigan Stroke Initiative and Detroit Operation Stroke (American Heart/Stroke Association). Participation in laboratory research with Dr. Kenneth Maiese is also available. His laboratory (funded in part by the American Heart Association) is currently evaluating the role of growth factors, signal transduction pathways, gene regulation, cellular metabolism, and metabotropic glutamate receptors in neuronal survival. Clinical DutiesClinical duties involved in the cerebrovascular disease fellowship include rotations in the stroke inpatient consultation service at Detroit Receiving Hospital, Harper Hospital, and the Rehabilitation Institute of Michigan. Additionally, a cerebrovascular disease clinic is held twice a week that is staffed by the stroke attendings. Training and research in neurosonology will also be provided. Other training opportunities include rotation through Hematology, Endocrinology, Cardiology, Neurorehabilitation, Neurosurgery, Neuro-critical care, and Neuroradiology services and working with Biostatistics and the Center for Health Effectiveness Research (CHER). A full-time stroke clinical coordinator assists the fellows in their clinical activities. Acute Stroke CallAcute stroke call is taken in rotation with all the physicians. The physician on-call assists neurology residents in evaluating patients for intervention with acute intravenous and intra-arterial thrombolytic therapy as well as several experimental neuroprotectants. The neurological critical care clinical experience includes caring for patients in the 10-bed Neurological Intensive Care Unit and consultation regarding neurological and neurosurgical emergencies. Emphasis is on vascular disease and trauma. Fellows will be formally trained in part using a curriculum proposed to the American Academy of Neurology Section on Stroke and Vascular Neurology. This includes the clinical experiences of the outpatient stroke clinic, inpatient stroke service and stroke unit, neuro-ICU, neurovascular ultrasound laboratory, didactic lectures, stroke conferences, reading assignments, journal clubs, symposia, courses, skills workshops and personal mentoring. Specific areas of targeted interest and research will be available as fellows demonstrate mastery of the general subject matter of the curriculum. Fellows meet regularly with faculty and the program director to provide feedback about performance and to advise the trainees. Fellows are encouraged to maintain a clinical log of patients seen and evaluated with diagnosis and management to assure that the diversity of stroke and vascular neurology cases have been seen and that an understanding of the material has been achieved. Based on the training provided, fellows will be eligible (and expected to take) the certification examination for the American Society of Neuroimaging (ASNI). Trainees are asked to complete an evaluation of the program (Strengths and weaknesses) and the faculty complete formal evaluations of the trainee after each rotation/section of the fellowship. Core knowledge (evidence-based when possible) for the WSU stroke fellowship that will be provided includes: Stroke mechanisms (specific and encompassing many different diseases and conditions), mechanisms of brain ischemia and hemorrhage, pathophysiology, clinical manifestations of the spectrum of stroke syndromes, diagnostic and therapeutic considerations, neuroradiology (CT, MRI (DWI, PWI, flare, conventional sequences), MRA, conventional angiography, SPECT, PET, Xenon-CT, spiral-CT angiography), neurosonology, neuro-critical care, neurorehabilitation, stroke scales (including certification on the NIH Stroke Scale), neurobehavioral and language/speech disorders, epidemiology, clinical trials, ethics, and research methodology. RequirementsRequirements for successful applicants for a cerebrovascular disease fellowship include completion of a residency in Neurology and ability to obtain medical licensure in Michigan. Applicants for the neurological critical care fellowship may have completed Neurology, Neurosurgery, Anesthesiology, Emergency Medicine, or Pulmonary and Critical Care Medicine training. Interested applicants are asked to send a complete CV/Bibliography and 3 letters of reference including one from the neurology training program director and/or Chair to: Contact: Seemant Chaturvedi, M.D.
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