The Ambulatory Care Center of the ANI allows patients to be referred for expert neurologic consultation in any of the major subspecialties of Neurology. Appointments are provided promptly, our staff always striving at accommodating the needs of patients and referring physicians, including urgent consultation and care. In addition, the Ambulatory Care Center allows the performance of diagnostic and therapeutic procedures for which hospitalization is not required.

The ANI has neurologists dedicated to inpatient care, including the urgent assessment and treatment of neurologic emergencies, as well as their comprehensive care throughout the hospitalization. In particular, our faculty is highly specialized in:

+ Vascular Neurology.

The newest officially recognized subspecialty of Neurology. It is concerned with the diagnosis and treatment of stroke and related disorders. Our vascular neurologists are experts in urgent assessment of patients with evolving stroke (including brain hemorrhages), their early and definitive treatment (including the administration of intravenous and intra-arterial thrombolytics), and their comprehensive diagnostic evaluation. The latter is a strategy we have championed for over two decades, and that results in optimization of outcomes and reduction of stroke recurrence.

+ Critical Care Neurology.

Our neurologists are also among the few in our country who are specialized in providing comprehensive critical care to neurologic patients. Our critical care team is capable of carrying out all types of life support protocols, including preservation of neurologic function in conjunction with cardiovascular, respiratory, nutritional and metabolic support. Our ability to rapidly assess and treat life-threatening neurologic conditions sets us apart from other groups, and results in improved outcomes and reduction of complications. In addition to stroke (including brain hemorrhage), we provide critical care for head injuries, seizures refractory to treatment, infections of the nervous system (such as meningitis), myasthenia gravis crises and inflammatory polyneuropathies with respiratory failure. The use of state-of-the-art critical care techniques such as hypothermia (lowering the brain temperature) is common to our daily practice.

+ Inpatient Neurologic Consultation.

Our physicians also have the ability to provide consultative support in cases in which patients are admitted to the hospital for another reason and require neurologic assessment. In particular, our ability to assist primary physicians and other specialists in the evaluation of incidental or complicating neurologic problems adds a dimension of comfort and clinical success.

At present, a large proportion of neurologic diagnoses depend on expert interpretation of images of the brain and the spinal cord. These digital images, which typically include computed tomography (CT) and magnetic resonance imaging (MRI), can be transferred electronically into the Neuroimaging Core Laboratory (NCL) of the ANI. Here, our specialists are able to review them and interpret them in the context of the clinical information provided, reaching diagnostic and therapeutic opinions that assist referring physicians in planning the best course of therapy, or further evaluation. Neuroimaging consultation is a very practical form of telemedicine, that saves time and increases efficiency of care. Finally, many neurologic conditions can be diagnosed very early (before they cause significant damage) by the expert utilization of neuroimaging techniques. Our program also allows us to screen patients at risk and to provide them with expert advise about treatment options and prognosis.

One of the most important areas of expertise of our physicians is the treatment of patients with stroke or at risk for stroke by using endovascular techniques. These involve the use of miniature tubes and wires to access the brain blood vessels from within, and then repair abnormalities that place the patient at risk for stroke. In addition, in certain cases of severe stroke, the ability to rapidly open a closed brain artery can lead to restoration of blood flow and improved outcome. In many instances, however, the simple application of a test known as angiography allows our physicians to identify abnormalities of the brain vessels that can lead to stroke and that can be corrected using the techniques described above. Our team’s extensive experience is evidenced by one of the lowest rates of complications and better series of outcomes in the country. Patients are referred from all over the world for neuroendovascular evaluation and treatment.

The ANI physicians are also trained in the performance and interpretation of tests designed for measuring the electrical activity of the brain and the peripheral nerves under a variety of circumstances. In general, the most important of these procedures are:

+ Electroencephalography (EEG)

This involves the recording of electrical activity from the brain surface through wires on the patient’s scalp and it is very important in conditions such as epilepsy. This test can be done in ambulatory or hospitalized patients. In addition, it is possible to conduct continuous EEG monitoring under circumstances that require a more specific or critical diagnosis and follow up.

+ Evoked Potentials (EP)

These are waveforms recorded also through the scalp but are generated by different systems within the brain in response to specific types of stimulation, for example Visual Evoked Potentials (measuring the conduction of the visual pathways), Brainstem Auditory Evoked Potentials (measuring conduction in response to auditory stimuli) and Somatosensory Evoked Potential (measuring conduction of sensory stimuli within the nervous system).

+ Nerve Conduction Velocity Studies.

These tests are designed to evaluate the function of peripheral nerves, often affected by many conditions such as diabetes. They are also useful in defining the cause of the peripheral nerve disorder, and to follow the effect of treatment.

+ Electromyography (EMG)

This is a test that involves the recording of electrical activity directly from muscles. This type of recording is most useful in differentiating diseases that affect the muscles directly (such as muscular dystrophy) from diseases resulting from abnormal electrical control of the muscles (such as Amyotrophic Lateral Sclerosis or Lou Gehrig’s).

Disorders of sleep have been recently associated with an increased risk for stroke and other neurologic problems. At the ANI, we have been able to structure a highly sophisticated sleep disorders program, capitalizing in the neurological expertise required to understand the physiology of sleep and its derangements. Diagnostic evaluation (including polysomnography and multiple sleep latencies studies) is easily scheduled and, if necessary, followed by therapeutic trials designed at assessing the beneficial impact of treating the diagnosed abnormalities.

Low back pain is one of the most common causes of disability in our country. Although many patients with low back pain require surgical exploration and treatment, many are not candidates for surgery or have failed to improve following surgery. In many of these cases, the patients will be candidates for spinal decompression, a non-invasive program that promotes healing of intervertebral disks and improves the patient’s quality of life. This program, in fact, does not compete with surgical treatment, but rather complements it.

The risk of stroke associated with hormonal changes, pregnancy and delivery, highlights the importance of expert neurologic care. Our neurologists provide a comprehensive approach to the reduction of stroke risk in women, taking into consideration their inherent characteristics. By partnering with the Women’s Center at Brookwood Medical Center, the ANI has dedicated itself to the elimination of disparities in delivery of care to women at risk of stroke, targeting the reduction of stroke morbidity and mortality.