Twenty years ago, when I first started to work in neurology, many patients would have died. We would have told the family, ‘We are very sorry, but we can’t do anything for your loved one.’ Today, we are able to take these patients – from a situation where they had little chance for survival – and help them recover and live a normal life,” says Dr. Roni Eichel, director of the Abraham & Lola Borg Stroke Unit and Neurological Intensive Care Unit at Shaare Zedek Medical Center in Jerusalem.
Eichel stresses that improved treatment of strokes is one of the most significant developments in modern medicine.
He cites a case where a pregnant woman who had suffered a major stroke was brought in to the hospital. “She had an obstruction of a brain artery that was very uncommon and particularly rare. She was treated quickly and effectively, and her unborn child was not endangered. She recovered, and both she and the baby are fine.”
He mentions other serious stroke cases where patients would have died, had their arteries not been reopened. Eichel reports that in many cases, these patients recovered with few scars.
In less than three years, since the opening of the Helmsley Neurological Institute in November 2016, Shaare Zedek has become one of Israel’s leading centers for the diagnosis and treatment of strokes.
A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptures, obstructing blood flow to the brain. Within moments, brain cells begin to die.
Eichel explains that in treating strokes, time is the key factor. “Every minute that passes that a stroke patient is not treated, two million brain cells die, so the treatment has to be fine-tuned to be faster, faster and even faster.”
Shaare Zedek has a special “fast stroke track” that helps to quickly diagnose and treat patients who have suffered a stroke.
Eichel says that with the fast stroke track, “the idea is that, instead of the patient waiting for the system, the system waits for the patient.” Together with Magen David Adom, the hospital developed an app that enables them to obtain essential medical information while the patient is en route to the hospital. Immediately upon arrival, a physician and nurse receive the stroke patient and set up a CT scan to assess the situation. A senior stroke physician is always available online for video conferencing to manage cases and make quick decisions.
Prof. Natan Bornstein, director of the Helmsley Neurological Institute, explains that while many understand the symptoms and signs of heart attacks, such as chest pain, most people are frequently unaware of the symptoms of brain dysfunction expressed by a stroke. These symptoms can be numbness or weakness in the face, arm or leg, confusion, difficulty understanding other people, and trouble seeing with one or both eyes. All of the emergency room staff at Shaare Zedek have undergone intensive training to know and identify stroke symptoms.
If diagnosed quickly enough, many strokes are able to be treated by administering a special drug, known as Alteplase r-tPA, through an IV in the arm, which dissolves the clot and improves blood flow to the part of the brain that has been affected. This treatment is known as IV-TPA. In other cases, patients are treated via endovascular intervention, in which micro-catheters – special thin tubes – are inserted into the blood clot in the brain via the groin and used to remove the clot.
Dr. Yaakov Amsalem, Corylee Jan Spiro Chair in Interventional Neuro-Radiology, is the director of the Lee and Anne Samson Interventional Neuro-Radiology Unit, which handles the complex specializations of brain catheterization strokes, aneurysms and other neurological episodes.
According to statistics from the Health Ministry, in 2017 Shaare Zedek performed more IV-TPA injections and endovascular procedures than any other hospital in Israel.
“It is amazing,” says Eichel, “that in just three years, we have been able to develop a center that provides nearly all the neurological services – neurosurgery, neurology, neuroradiology, diagnostic neuroradiology and conventional radiology.”
Bornstein adds, “Our model for emergency room stroke care is now being followed by many hospitals.”
Shaare Zedek has 10 neurologists on staff and treats 1,200 stroke patients per year. Stroke care at the Neurological Institute extends beyond the treatment for the stroke itself to preventive measures to evaluate the patient’s situation and prevent a second, more severe stroke.
Bornstein credits the hospital administration and its supporters for recognizing the need to invest in a comprehensive neurological service and explains that the institute has four main sections – the 20-bed David & Ann Kuppermann Neurology Department, the 24-bed Zvi Weinroth Department of Neurosurgery headed by Dr. Nevo Margalit, the Borg Stroke Unit, and the Lee & Anne Samson Interventional Neuroradiology Unit, which performs brain catheterization for removing blood clots from the brain, as well other neurosurgery catheter procedures.
Shaare Zedek’s activities in neurological health extend beyond neurosurgery and strokes.
“We are developing a center for headache treatment,” says Eichel. “Headaches are very common and are very underestimated in terms of how they can affect patients.” Workdays missed due to headache pain are a financial burden on the economy.
Eichel explains that treatment for headache pain is now much more developed and complex than in the past. Headaches are treatable with many variations of medications, as well as biofeedback, alternative medicine and psychological involvement.
“It takes a multidisciplinary approach to treat headache patients,” he says.
Shaare Zedek’s headache clinic is staffed with three headache specialists.
In addition to its direct treatment of neurological patients, the Neurological Institute conducts academic activity and research in all areas of neurology for young neurologists and nurses.
Says Eichel, “We also want to bring greater awareness to the population. Our vision is to continue to supply quality professional services in all areas of neurology for Jerusalem’s residents, by providing compassionate and professional treatment.”
He is enthusiastic about new developments in the treatment of strokes. “Today, we are treating more patients – even more complex cases – both because of new technology and because of new medical guidelines that allow treatment of strokes in some cases up to 24 hours after the event.”
“I’ve been in many countries,” says Bornstein, “and I have taught around the world – in China, the Philippines, India, Uzbekistan and Kazakhstan. Here in Israel, neurology is a very advanced discipline in terms of knowledge, technology and treatment. A great deal of research is conducted here, and it is appreciated all over the world.”
Bornstein, who is one of Israel’s most respected veteran neurologists with over 35 years of experience in the field, says simply, “The spirit of Shaare Zedek is something special.”
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