Young Stroke Program
The Stanford Stroke Center Young Stroke Program
To date there have been very limited research and public health efforts aimed specifically at addressing stroke in young people. Clinically, this has also been a neglected area with few, if any, Centers developed specifically targeting stroke in the young adult. Caring for and managing young patients with stroke requires a multi-disciplinary effort with experts from a variety of areas. Connections and collaborative networks between neurologists, neurosurgeons, interventional and diagnostic neuroradiologists, cardiologists, hematologists, oncologists, rheumatologists, obstetricians, geneticists, and many others must be strong. Rehab physicians, therapists, psychiatrists, neuropsychologists, nutrition experts, and social workers may play an essential role as well. To care for this population in a comprehensive manner, and to do it correctly, really does “take a village”.
We have launched our Young Stroke Program at Stanford that leverages the unique milieu that we are fortunate to be a part of at this university. The Stanford Stroke Center sits within the Department of Neurology and Neurological Sciences in the School of Medicine at Stanford University. Through close collaboration with Stanford Health Care (including both inpatient and outpatient facilities) and other clinical and basic science departments within the School of Medicine and the larger University, a tremendous number of resources can be brought to bear on the care, management, and research for the young stroke patient.
The Program builds upon the expertise Stanford has with stroke in general, but with a particular bent toward the unmet need of stroke in the young patient. Founded in 1992, the Stanford Stroke Center has been the model for multi-disciplinary stroke care that centers around the world have emulated. As the first academic Joint Commission-certified Primary Stroke Center in California, and the first Comprehensive Stroke Center in the country, Stanford has many years of experience bringing together multiple parties within a larger system of care. Research and educational programs administered through the Stanford Stroke Center have been well-established and remarkably successful for almost three decades. Similarly, the three-part mission of the Young Stroke Program is to develop excellence in clinical care, research, and education.
The Young Stroke Program extends along the entire continuum of clinical stroke care for young adults including diagnosis, acute treatment, ongoing management, prevention, and recovery. The entry point for the individual patient could be in either the acute inpatient setting or in the outpatient clinic. The clinic will be staffed by Drs. Neil Schwartz and Sarah Lee, often in conjunction with a Vascular Neurology fellow, a RN, and potentially other trainees. Efforts are made in advance of the clinic visit to coordinate care with other needed specialists and diagnostic studies to make the evaluation more time-efficient for the patients and their families. The approach is both personalized and patient-centered, with an eye toward meeting the needs of our young adult stroke patients and their families. Clinic visits are comprehensive and unhurried. Patient and family education is a top priority as we have found there is often a lot of anxiety present from interaction with previous health care providers that may not have had much experience with stroke in young patients. Our main goals are to provide the correct diagnosis, the correct treatments, the correct prevention regimen, and the correct path forward to recovery.
Research efforts within the Young Stroke Program will be built upon the clinical framework. We will be caring for a population of exceedingly well-characterized patients. As there is often a great deal of “detective work” that goes into understanding stroke etiology in a young person, a number of diagnostic tests are typically performed, including such things as multi-modal brain imaging (CT and MR-based), vascular imaging (CT, MR, ultrasound, and conventional angiography), cardiac evaluations (of both heart structure and rhythm), and multiple blood tests for genetic and acquired factors of hypercoagulability and other conditions. Other diagnostic tests for specific genetic conditions, spinal fluid analysis, imaging of other parts of the body, etc may be required. Patients will also be very well characterized from an historical and physical exam standpoint. Together we will have a rich database from which to draw from to ask, and hopefully answer, clinically relevant questions about stroke in the young adult patient. Further, the ability to sequence the whole exome or genome of our patients is not a future fantasy; it is here today. Through collaboration with basic science investigators we can look for novel genotypic-phenotypic relationships in our patients. We will be collaborating with colleagues in the Stanford School of Medicine’s Quantitative Sciences Unit (QSU), experts in clinical trial design, biostatistics, Big Data, and informatics. The ultimate goal of this is not strictly academic, but rather to identify novel associations and potential targets for screening, treatment, and prevention of stroke in our young adult patients.
Education of our students and housestaff is an important aspect of the Young Stroke Program. The Program provides a unique educational opportunity for our trainees to be involved in the evaluation and care of this specialized population, as well as opportunities to engage in cutting-edge research. They learn valuable skills they can bring to their own practices, whatever field they end up choosing. As stroke as a disease model cuts across nearly every field of medicine, regardless of their path, all of our trainees will have the opportunity to see stroke patients again. We are hopeful that our trainees will be able to increase awareness of stroke in young adult patients in their own professional practice, and impart their knowledge to others. The Young Stroke Program may also serve as an organizing mechanism for symposia or conferences on the subject, giving a much needed forum to this often neglected population of stroke patients.
Through the Young Stroke Program, there is the potential for public health efforts and an extension into the community outside of our walls. This would include educational efforts and media outreach aimed at other health care providers, the general population, particularly adolescents and young adults, and even policy makers. These latter efforts would be aimed at increasing awareness in our community about stroke in young patients and increasing access to resources for young stroke patients, their families, and their caregivers.