Neurovascular (Stroke)
 


​​​Neurovascular (Stroke)

Introduction:

The Vascular Neurology (Stroke) Fellowship is a one-year, AKU PGME accredited training programme since 2009 through the department of medicine, division of Neurology.  It offers comprehensive training in the management of cerebrovascular diseases, including experience in acute stroke treatment, diagnostic evaluation, and the management of complicated cerebrovascular disorders. 

The Vascular Neurology Fellowship at AKU follows the curriculum proposed by 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 acute stroke unit, neurosonology laboratory, didactic lectures, departmental 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 .Core knowledge (evidence-based when possible) that will be provided includes: mechanisms of brain ischemia and hemorrhage, pathophysiology, clinical manifestations of the spectrum of stroke syndromes, diagnostic and therapeutic considerations, neuroimaging modalities (including CT, MRI, MRA neck and intracranial, conventional digital subtraction angiography and rotational angiography, , transcranial Doppler ultrasonography, and carotid ultrasonography and Duplex imaging), key issues in 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. 

Currently the programme offers opportunities for extended research and academic training for interested participants.  This is in addition to the programme description that follows, interested clinical researchers may want to pursue this further. 

Objectives 

The objective of the programme is to produce competent clinical and academic vascular neurologists.

Duration of Training 

Training period is one year.

Eligibility 

MBBS degree approved by PMDC
FCPS Part One
Intermediate Module Exam of CPSP

Facilities and workload: 

Neurology at AKU started as a consultation service in 1987 with one faculty member.  Over the years, it has expanded to a major division nationally recognised for its faculty, residency training program, and academic and research contributions.  It receives referrals from throughout Pakistan and Afghanistan and leads all other neurology programs in the country in research output and extramural funding.  Currently, the division has the largest neurology faculty in Pakistan comprising six full-time and six part-time faculty members.  Almost all of them are engaged in research that is relevant to the national non-communicable disease agenda of stroke.

It has a track record of stroke related publications and the division is recognised as a national leader in stroke care and research. 

A multidisciplinary stroke clinic was inaugurated in 2007 and is the first neurovascular clinic of Pakistan.  It is manned by a team headed by a stroke neurologist that includes specialised stroke nursing, physiotherapists, speech therapists, and occupational therapists; a vascular surgeon and interventional radiologist are on standby.  This clinic has so far systematically served, evaluated and followed 1,140 patients. 

The stroke unit at Aga Khan University Hospital has dedicated stroke care beds; it is one of only two stroke units in Karachi, a city of 18 million people.  This unit has performed a series of clinical “firsts” in Pakistan – the first decompressive hemicraniectomy, the first use of intra-arterial recombinant tissue plasminogen activator, and management of patients with stents after carotid artery intervention.  The monthly census is about  60 – 80  patients of  vascular disease per month. 

Scope and Content

Clinical Training 
Fellows will be busy mastering in-hospital clinical duties starting with emergency room urgent evaluation (quick examination and imaging interpretation, plus clot dissolving agent administration “rTPA” according to national protocols), triage (admission to regular vs. intensive care units), in-house follow up evaluation and stabilisation of critical patients, and then determination of future prognosis.  As part of the daily routine, the fellows will be familiar with sophisticated laboratory testing and advanced neuroimaging including arteriography and trans-esophageal echocardiogram.  Fellows will be required to formulate urgent and long term treatment plans based on each case.  In addition, they will have outpatient duties such as following up patients after discharge from hospital in stroke clinic.  In addition they will be involved in teaching neurology residents and rotating medical students , and elective students.

Curriculum Outline
The fellow will go through the following designated rotations – inpatient stroke, neurosonology, neuroradiology, echocardiography and rehabilitation.  Specialty training is available in all areas of stroke care including: intensive care, advanced neuroimaging, non-invasive neurovascular procedures, neurorehabilitation, neurobehavioral and language/speech disorders, epidemiology, ethics, research methodology and clinical research.  Didactic teaching is emphasised throughout the fellowship: 

  1. Conferences.  Weekly one hour duration Monday Morning Journal Clubs that are based on the evidence based curriculum, and weekly Friday Lecture series which is a multidisciplinary series dedicated to vascular neurology is ongoing.  The Thursday neurology case conference in particular affords the opportunity to interact with our neurosurgical, neuroradiology, interventional radiology, and other colleagues and attendance is expected and encouraged.  A Stroke Conference is held where fellows and stroke faculty present the latest information on stroke diagnosis, evaluation, and treatment. 
  2. Neurosonology Training.  Full training in the interpretation of both carotid artery duplex sonography and transcranial Doppler studies will be provided.  The neurosonology period will be spent using and learning multiple clinical and research applications of transcranial Doppler on a wide variety of patients. 
  3. Acute Stroke Code Call.  All patients with hyper acute stroke less than 4.5 hours since onset are routed through the vascular fellow who provides direct supervision during working hours, phone back up at night and may be required to come in at night if the patient’s condition warrants direct review.

Research 

The fellow will write a focused, feasible proposal and go through the process of grantsmanship by submitting to the University Research Council.  All fellows will submit evidence based reviews to the local journal for publication in the section of “Evidence based Medicine” of the Journal of the Pakistan Medical Association.  They will have direct mentoring and are expected to participate in the ongoing sectional research activities and ongoing clinical trials.  Additionally they will compete for the summer biostatistics course offered by the Department of Community Health Sciences at the Aga Khan University. 

It is our goal to have each fellow first author at least one published manuscript by the end of the year, and to include the fellow as a co-author in any project or manuscript in which s/he was directly involved, including all abstract submissions and publications occurring after completing the fellowship.

Conferences: 

Fellows are required to attend at least one educational conference during their one year of training. 

Supervision: 

The fellows will be assigned a faculty supervisor on each rotation or clinical experience (inpatient or outpatient).  The fellow will be supervised directly at all times by one of the faculty members.

Evaluation and Feedback 

Continuous assessment and verbal and scheduled written feedback will be provided.  Written MCQ examination at the end of the year is planned. 

Positions available

One per year

Administrative set up 

Full-time Faculty Neurology 

Associate Professors

Dr Ayeesha Kamran Kamal
MD, FAHA, ABVN, ABPN

Dr.  Mohammad Wasay
MD, FRCP, FAAN

Dr Saad Shafqat
MBBS (AKU); PhD Neuroscience (USA),
Diplomate American Boards of Neurology and Psychiatry 

Assistant Professor

Dr Bhojo Asumal Khealani
MBBS (Sindh), FCPS (Pakistan)

Lecturer

Dr Aziz Sonawalla
MBBS (India), M.D (Medicine), D.M (Neurology)​

Multidisciplinary Resource Faculty 

Neuroradiology

Dr. Zafar Sajjad
Associate Professor
MBBS, MRCP (UK), FRCR

Neurosurgery

Dr. Ather Enam
Associate Professor
MD, PhD, FRCSI, FRCSC, FACS, DABNS

Rehabilitation

Dr. Nabila Soomro
Lecturer
MBBS, FCPS Physical Medicine and Rehabilitation (Pakistan)
Critical Care

Dr. Nawal Salahuddin
Associate Professor
MBBS, FCCP, American Boards Internal Medicine,
Pulmonary and Critical Care Medicine

Echocardiography

Dr. Sohail Abrar Khan
Assistant Professor
MBBS, FCPS (Medicine), FCPS (Cardiology)​

Related Links

How to Apply