Within the human brain, a series of neural pathways links each lobe and cortex, supporting an electrochemical process that turns signals into movement and sensory information into thoughts and actions. In much the same way, the neurology specialists at MidHudson Regional Hospital are connected to all of the neurology services within the Westchester Medical Center Health Network — for patient care, turning a community hospital into an academic center, a hub for research and clinical trials, and an advanced Neuroscience Center, all in Poughkeepsie.
The newly expanded department now hosts a team of specialists whose array of expertise ranges from stroke and vascular intervention to neurosurgery to movement disorders.
The neurological program is designed to address the full spectrum of medical and surgical treatments for common diseases. Conditions treated include chronic pain, cerebrovascular disease, epilepsy, gait and balance disorders, multiple sclerosis, neurogeriatric memory disorder, neurotrauma, Parkinson’s disease, peripheral nerve injury, sleep disorders, and stroke. Should patients require more advanced treatment, the partnership with Westchester Medical Center ensures that the MidHudson Regional Hospital team remains involved and can complete any and all follow-up care.
Located in one office, the team includes Michael Cho, MD, FAANS, Associate Director of Neurosurgery; Fabio O. Danisi, MD, Associate Director of Neurology; and Q. Tony Wang, MD, PhD, Stroke/Vascular and Interventional Neurologist. In addition, Michael F. Stiefel, MD, PhD, Chief of Neurovascular Surgery and Director of the Neurovascular Institute, who primarily practices at Westchester Medical Center, assists in treating cerebral vascular disease.
“The idea is to create a program where there are skilled specialists available to care for patients here in the Poughkeepsie area until the point that they need referral to our tertiary center for a further level of care,” said Dr. Danisi. “That’s a very realistic and achievable goal.”
Fabio O. Danisi, MD, Associate Director of Neurology, discusses dystonia (spasmodic torticollis) with a patient.
Michael Cho, MD, FAANS, Associate Director of Neurosurgery, reviews an upcoming procedure with Medical Assistant Rachel Burnett.
Acute Stroke Intervention
In June of last year, the American Heart Association and the American Stroke Association revised the guidelines for the management of acute ischemic stroke, pairing tissue plasminogen activator therapy with evaluation for endovascular treatment in patients who meet the exclusion criteria. Last November, MidHudson Regional Hospital launched its dedicated comprehensive stroke program, which incorporated endovascular intervention into its suite of available medical treatments.
As Dr. Wang explained, the program’s approach to treatment begins with its four types of imaging: computed tomography, computer tomography angiography, magnetic resonance angiography and magnetic resonance imaging.
“With these imaging technologies, we can evaluate the brain, the tissue and the blood vessels inside and outside the brain,” he says. “It gives us a rapid understanding of the problems we’re dealing with and a great idea of how to best approach the lesion.”
Imaging also helps determine a patient’s candidacy for endovascular intervention. For ischemic stroke, this involves placement of a retrievable stent into the target vessel to remove the blockage. In the case of a hemorrhagic stroke from a ruptured aneurysm, Dr. Wang employs coils with alloyed fillers to seal the aneurysm from the inside, creating a mechanical barrier to blood flow.
While the vast majority of patients will receive their full treatment in Poughkeepsie, more complex cases can be transferred to Westchester Medical Center. For Dr. Wang, who also practices in Valhalla, the partnership’s advantage emerges in the access to an advanced academic facility.
“We’re not just a community hospital affiliated with an academic center,” Dr. Wang says. “We are the academic center in the community.”
In the OR
A familiar face in Poughkeepsie, Dr. Cho arrived in the Hudson Valley in 2006. The scope of his practice includes brain and spinal cases, such as brain bleeds and tumors, disc herniation, and spinal stenosis related to degeneration, as well as diseases such as hydrocephalus. In addition, as the primary neurosurgeon at MidHudson Regional Hospital for many years, he has a significant background in trauma neurosurgery, particularly with regard to cervical, lumbar and thoracic fractures.
“Between the surgery for brain trauma and also for spine trauma, we’ve achieved very good outcomes,” Dr. Cho says. “Patients who have come in badly hurt have made nice recoveries.”
In a recent case, a 27-year-old man presented with fractures and dislocations in both his second and third lumbar discs. Dr. Cho successfully realigned, fused and instrumented his spine. Four months later, the patient regained bladder and bowel control and was walking with the aid of a walker. Dr. Cho is confident the patient will improve to the point of walking independently.
With non-trauma cases, however, he is not quick to recommend surgery. Dr. Cho performs all of his own evaluations, thoroughly considering the benefits and potential complications of open intervention.
“I tend to be a conservative surgeon,” Dr. Cho says. “I aim to provide appropriate care for the patient’s condition. That’s always been my philosophy, and it’s best for the patient.”
The Lifelong Relationship
Just down the hall in his exam rooms, Dr. Danisi also utilizes one-on-one time with his patients to attain a full picture of their conditions.
“We still rely heavily on the old-fashioned history and examination, much more so than in most other specialties,” he says. “So much of what we do has to do with getting a thorough history and examining very carefully.”
For the movement disorder specialist, those evaluations most commonly focus on cases of Parkinson’s disease, dystonia and essential tremor. These diagnoses entail a great deal of attention, often making the relationships between Dr. Danisi and his patients long-term. The conditions can be treated with medical therapy or with interventions, such as botulinum toxin injections, intrathecal baclofen pump management and deep brain stimulation surgery.
While his background in clinical research provides a familiarity with both medical and surgical options, Dr. Danisi’s more than 20 years of experience allow him to correctly diagnose puzzling movement disorders. Dystonia, for example, is often overlooked, despite affecting up to 250,000 Americans, according to the American Association of Neurological Surgeons. The condition involves involuntary muscle contractions and typically causes abnormalities in posture and voice. Dr. Danisi addresses the condition with injections of botulinum toxin as a means of targeting the abnormal electrical stimulation occurring in the parts of the brain associated with the overactive muscles.
“The injections tend to help the brain forget about that body part and stop overreacting to misinterpreted sensory input,” he says. “With the treatment, posture improves and abnormal movements disappear. Pain can also decrease and patients’ functional abilities can improve.”
For more rare conditions, Dr. Danisi has worked with colleagues to create an archive highlighting the connection between genetic abnormalities and movement disorders. Using information from video assessments and blood draws, the consortium analyzes the statistical correlation between DNA anomalies and clinical findings within families with multiple movement disorder diagnoses.
The Advantage of Expertise
For Dr. Danisi, that kind of ability to maintain a focus on his specialty, along with the opportunities to collaborate with his peers at MidHudson Regional Hospital in treating more complex cases, provides the ideal setting for quality patient care. That setting is now enhanced through the partnership with Westchester Medical Center Health Network.
“We’re the only academic medical center in the Lower Hudson Valley, and the only center between Albany and the five boroughs with neurosurgeons and neurologists who specialize in all aspects of cerebrovascular disease. Regardless of how the patient needs to be treated, we can handle it.”
— Michael F. Stiefel, MD, PhD, Chief of Neurovascular Surgery and Director of the Neurovascular Institute at Westchester Medical Center Health Network
As Dr. Stiefel explains, in a process that began in the fall of 2010, the neurology services at the system’s Hudson Valley facilities have been modeled after those at major academic centers. First, infrastructural concerns were streamlined, ensuring that the teams of providers — nurses, technicians and physicians — were working together seamlessly. Second, the attention turned to MidHudson Regional Hospital and the buildout of a staff of neurology specialists.
From a regional perspective, the result is a healthcare resource comparable to those of the Mayo Clinic or Cleveland Clinic, with ongoing research and education, leading-edge diagnostic and treatment technology, and continuous communication between providers and facilities all available within the Hudson Valley.
“What’s important to understand is that it’s okay for one facility to not offer every possible procedure, but you want a health system that does,” Dr. Stiefel says. “The patient benefit comes from high volume and the network having the ability to take care of every type of patient. In neurosurgery and most surgical specialties, high volume is associated with better outcomes. Just because a hospital has the ability to do a procedure, doesn’t mean its quality and outcomes are good. In fact, data suggests the opposite — low volume is correlated with worse outcomes.”
Q. Tony Wang, MD, PhD, Stroke/Vascular and Interventional Neurologist, consults with a patient about stroke prevention.
Drs. Wang and Danisi compare imaging scans for a new patient.
For more information about the neurology services available at MidHudson Regional Hospital, visit midhudsonregional.org/neurosciences.