Neurology and Neurosurgery-Hahnemann University Hospital-Philadelphia, PA

Time is critical when a cerebrovascular emergency or stroke occurs. Hahnemann University Hospital can assemble a Rapid-Response Stroke Team within minutes to provide diagnosis of vascular lesions, intervention and speedy treatment. The stroke team is available around the clock and provides thrombolytic and other therapies which help patients avoid the potentially devastating consequences of a stroke. When patients come to the Hahnemann Emergency Department within three hours of stroke onset, the team can administer treatments such as clot-busting drugs and perform neuroradiology procedures to minimize damage and complications. Hahnemann has Medevac helicopter capability and accepts transfers from other hospitals.

In addition to treating patients who require urgent diagnosis and treatment while a stroke is in progress, the Acute Stroke team also provides vital services to others who need comprehensive evaluations to reduce their risk of recurrent stroke and/or those who may benefit from planned rehabilitation and home care after suffering a stroke.

The Acute Stroke program also offers preventive services, such as carotid stenting. This treatment involves the placement of stents, or mesh-like metal devices, in the carotid (neck) arteries to keep these blood vessels open. The center also maintains a suite containing a simulated patient to train medical professionals on how to perform the carotid stent procedure. Training classes are held for outside physicians monthly.

Hahnemann University has earned the Gold Seal of Approval™ from The Joint Commission for Primary Stroke Centers. Hahnemann University Hospital earned this distinction following a review by the Joint Commission. To learn more, click here.

Brain & Spinal Tumor

Professionals from the Brain and Spinal Tumor program treat primary brain tumors—that is tumors that have arisen from brain tissue itself—as well as complications of cancer in other places in the body, metastatic disease and complications from medical or radiation cancer treatment that affects the brain. Currently incorporating some of the newest technology for brain tumor treatment, the program remains true to the philosophy of personalizing treatment to each patient and addressing the impact of the diagnosis on patient, caregivers and loved ones. The team also works to promote communications with referring physicians, essential to continuity of care for each patient.

The multidisciplinary team includes:

Neuro-oncologist
Radiation oncologist
Medical oncologist
Neurosurgeon
Neurologist
Pathologist
Nuclear medicine specialist
Nurses
Social worker
Patient care coordinator

The patient care coordinator follows the patient through the treatment process and serves as the liaison among the clinical team and the patient, family and caregivers. Other services, such as nutrition advice, neuropsychology, physical/occupational and speech therapy are available.

With the support and expertise of the multidisciplinary team, patients with all brain tumors, including the most difficult ones, and patients who have recurrences, receive support in evaluating the available options, explanation of the treatment plan the team recommends and understanding the choices he or she makes.

Technology and treatment advances may help many brain tumor patients live longer, often with better quality of life. The Brain and Spinal Tumor program’s support helps centralize services and offer continuity and convenience important to patients and their families or caregivers.

The program’s screening and diagnostic services include:

Risk factor analysis
Neurophysiologic examination
CT, MRI, PET and SPECT studies
Computerized EEG analysis
Stereotactic guided biopsies
Neuropathology

The team tailors treatment options to the needs of each patient. Appropriate specialists see the patients in a single patient visit. Treatments may include:

Surgery
Whole or partial brain irradiation
Stereotactic radio-therapy which delivers a radiation dose to a specific target with accuracy, minimizing the radiation to surrounding tissues.
Access to appropriate national prospective randomized chemotherapy trials
Monoclonal antibodies which deliver radiation doses directly to cancerous cells.

The program’s clinical efforts are supported by research activities. The program participates in national cooperative group chemotherapy studies and ongoing basic research into newer and better methods to treat brain and spinal tumors.

Support groups for patients and families are another source of practical information and resources. Groups encourage greater participation by both patient and family in overall care. There are many such groups in the greater Philadelphia area.

Complex Regional Pain Syndrome (CRPS)

Complex Regional Pain Syndrome (CRPS) is a painful, chronic and disabling condition usually caused by an abnormal nerve response to trauma or injury. This condition is a major cause of undiagnosed pain and, until recently, victims had to suffer constant and debilitating pain.

Dr. Robert Schwartzman, Department of Neurology chair, is working with colleagues in Europe to develop new treatment options. Dr. Schwartzman has written extensively on CRPS and is an internationally-recognized expert on the disorder. Over his 40 years of practice, he has treated many patients with this condition.

Multiple Sclerosis: Neuroimmunology for Autoimmune Disorders

Dr. Schwartzman is studying the impact of high-dose chemotherapy on multiple sclerosis (MS) and other autoimmune diseases. The research uses the anti-cancer drug cyclophosphamide to treat patients with such diseases as multiple sclerosis (MS), lupus, myasthenia gravis and chronic inflammatory demyelinating polyneuropathy. Preliminary findings suggest that the drug destroys the damaged immune system, apparently allowing a healthy immune system to regenerate.

Epilepsy

Epileptic seizures occur when the balance between excitation and inhibition is altered in the brain’s network of nerve cells. Seizures manifest themselves in many ways—from a fleeting episode of staring to a convulsion. Recurring seizures are known as epilepsy. More than 2.7 million Americans of all ages are living with epilepsy and every year 181,000 Americans develop seizures for the first time. The condition can develop at any age but is more frequent in the very young and the elderly.

Epilepsy can have genetic or anatomical causes but in the majority of cases there is no apparent cause. Today, medication controls seizures for about two-thirds of patients and some others may be helped by other alternative therapies such as surgical treatment, vagus nerve stimulation or special diet.

The Epilepsy program’s goal is to improve seizure control and minimize the impact of epilepsy on everyday life.

Hahnemann offers an array of tests to fine tune treatment. The program cooperates with other Hahnemann professionals to provide multidisciplinary care. For instance, the staff works closely with pulmonologists who specialize in sleep disorders to diagnose and treat sleep disorders, and with neuropsychologists to evaluate different areas of brain function.

The neurophysiology laboratory aids in defining brain location and classification of different epilepsies.

Hahnemann’s neurophysiology lab offers:

Routine EEG recording in the lab
Ambulatory EEGs—outpatient monitoring
Inpatient workup—in the epilepsy-monitoring unit (EMU).
Neuropsychological evaluation that helps characterize strong and weak areas of patient functioning as well as cognitive function.

Different brain imaging technologies which include:

Diffusion tensor imaging
MR Spectroscopy—noninvasive localization of seizure focus
SPECT scanning—can show the brain region likely causing seizures
PET (photoemission tomography)
Wada testing—determines which side of the brain is involved in particular functions as no one’s brain function is localized exactly the same as another’s.
Functional MRI for brain mapping.

Because epilepsy is usually chronic, refractory cases need close clinical follow up. The experienced medical staff offers hands-on treatment and services to minimize the disability of epilepsy. The Epilepsy program uses many treatment modalities including medication, surgery, vagal nerve stimulator, neurofeedback and diet. Resective surgery options, when recommended, may be curative in many cases.

Ongoing research that patients may benefit patients involves neuroimaging, epilepsy in the elderly, new drug evaluations, aspects of sleep disorders and neurofeedback.

Gerald Ford Neurological Intensive Care Unit

Acute stroke patients who require intensive care are admitted to the Gerald Ford Neurology Critical Care Unit. This eight-bed, dedicated facility serves patients with acute stroke, intracerebral hemorrhage, subarachnoid hemorrhage, carotid stents, brain and spinal cord tumors and neuromuscular disorders. The Neurovascular team is on-call 24-hours-a-day and includes two neurointensivists, a neurosurgeon and an interventional neuroradiologist.

The unit is named for President Ford who came to Hahnemann for treatment after he suffered a stroke during Philadelphia’s 2000 Republican National Convention.

Memory Disorders

The goal of the Memory Disorders program is to stop the progression of, and provide practical management for, memory loss.

Although Alzheimer’s disease is a major factor in memory loss among older patients, it is not the only cause of memory or cognitive problems. The Memory Disorders team, led by neurologist and memory disorders specialist Dr. Carol Lippa, considers many factors as they evaluate patients who might have a memory disorder:

Is the decline greater than expected for a person of that age?
Could a treatable condition such as vitamin deficiency, thyroid problem or chemical imbalance be contributing to the memory loss?
Does the patient have dementia?
Is Alzheimer’s the correct diagnosis?

Once a diagnosis is made, the Memory Disorders professionals focus on practical management and early intervention to treat cognitive and memory disorders.

Specialized Memory Disorders services include:

A comprehensive outpatient facility
Cerebrospinal fluid analysis
MRI and PET scans
Neuropsychological testing
Access to clinical trials

The multidisciplinary team includes neurologists, nurses, neuropsychologists and geriatricians.

MDA/ALS Center of Hope

On an average day, 15 new cases of Amyotrophic Lateral Sclerosis (ALS) are diagnosed in the United States.

Also known as Lou Gehrig’s disease, this neuromuscular disorder is a degenerative disease that causes progressive weakness and death.

The Muscular Dystrophy Association (MDA)/ALS Center of Hope led by neurologist and MDA/ALS specialist Dr. Terry Heiman Patterson, is one of only 34 centers in the country and the only one in the Philadelphia region. The center was established in 1984 and remains one of the most experienced centers in the care and diagnosis of people with ALS. Its comprehensive program includes both clinical services and basic research. The centerpiece of clinical care is the multidisciplinary team of medical professionals who provide individualized attention to help patients and their caregivers manage their disease.

They also have convenient access to the EMG Laboratory where an experienced medical and support staff focus on patient comfort and skillful testing.

The MDA/ALS Clinic Team includes:

Neurologists
Clinical nurse coordinator
Mental health specialist
Social worker
Occupational therapist
Physical therapist
Speech/language pathologist
Dietitian/nutritionist
Clinical research staff
Administrative assistant
MDA representative
ALS Hope Foundation representative
Clinic volunteers

Each patient meets with the entire multidisciplinary team during every visit to the center, so that all problems and needs can be addressed during each visit. This comprehensive approach evolved from patient experience and also allows for important communication among the team in support of each patient.

The center stresses improved function and quality of life with initiatives such as “the Sanctuary,” a special inpatient suite that is, to our knowledge, the first of its kind in the country. Located in Hahnemann University Hospital, the suite is equipped with special assistive eyeblink- and voice-activated devices that allow maximum independence for persons with ALS as well as hospital bed, sleep sofa, microwave, refrigerator, computer, television and VCR. These amenities provide ALS patients with greater control over their environment and also provide caretakers with a unique “home away from home” during their loved one’s inpatient stays.

In addition to clinical services, the ALS center staff believes that research is a critical component of any ALS Center and therefore we maintain active clinical and basic research programs. Patients may have the opportunity to participate in clinical trials; clinical research programs; and are routinely educated about the ongoing basic research at the MDA/ALS Center of Hope and across the country.

Neurosurgery

Hahnemann’s neurosurgeons Dr. Francis Kralick, chief of neurosurgery, and Dr. Joseph Queenan, perform procedures using some of the latest techniques such as complex, minimally invasive brain and spine surgery with endoscopic and micro-surgical tools.

Our neurosurgeons treat a wide range of conditions:

Degenerative disc diseases
Brain tumors and skull-based lesions
Cerebrospinal fluid anomalies
Congenital malformations/tethered cord issues in adults
Adult patients with spina bifida

Post-operative patients maybe admitted to the Gerald Ford Neurology Critical Care Unit. Directed by neurointensivists, our team deals with brain swelling, cerebral perfusion, intracranial pressure and other potentially life-threatening complications of cerebrovascular disease.

Spine Care

In patients under the age of 45, low back pain is the number one cause of disability. In patients over 45, it ranks number two. Despite these statistics, with proper diagnosis and treatment, physicians can help many patients return to their normal activities.

The range of low-back-pain treatments is as broad as the causes of the pain. Our philosophy is: Begin with the least invasive treatment options. Surgery is always the last resort.

Our staff, led by neurosurgeon and spine specialist Dr. Francis Kralick, educates patients about their conditions, offers realistic goals for recovery, avoiding surgery whenever possible and minimizing invasive surgery for those patients who do need surgery. Our patient management guidelines are pain relief, improved functional ability and returning patients to their normal lifestyles as quickly and efficiently as possible.

We also find that rehabilitation alone is often the answer so physical therapists provide exercise and reconditioning programs designed for each patient’s therapeutic needs.

For the small percentage of patients who don’t get sufficient relief from other treatment options, our staff specializes in progressive surgical techniques.

Neurophysiology Laboratories

EEG Laboratory

The EEG lab is integral to the functioning of our epilepsy services because epilepsy patients almost always require EEG testing. The lab performs routine EEGs and ambulatory 24-hour EEGs which involve recording equipment that allows patients to go about their daily activities while any seizure activity is being recorded. The activity is analyzed later in the laboratory.

Other procedures include evoked potentials in which the patient receives visual, auditory or peripheral nerve stimuli while induced electrical events in the brain are recorded using scalp electrodes. This is often used in diagnosing multiple sclerosis.

EMG Laboratory

Patients from nearly all disciplines are referred to the EMG lab for further evaluation with neurophysiologic testing, nerve conduction studies and electromyography to better characterize:

nerve and muscle disorders
peripheral neuropathies
myopathies
motor neuron problems
radiculopathies (pinched nerves in the neck and back)
entrapment neuropathies (like carpal tunnel syndrome)

The staff physicians and technicians are experienced and pay careful attention to minimizing patient discomfort during these examinations.

Quantitative Sensory and Autonomic Testing Laboratory

This testing requires complex and highly specialized equipment, training and experience. It is not performed in most hospitals or medical settings and is usually available only in select places where the medical staff has a significant interest in evaluation and treatment of peripheral neuropathies. Quantitative sensory and autonomic testing is complementary to the nerve conduction and electromyelography studies performed in the EMG lab.

This testing is an evolving science and is currently used in evaluating pain conditions, diabetic neuropathy, toxic neuropathy and as part of the testing in new-drug clinical trials where appropriate. By being able to record quantitative tests, clinicians are able to begin to determine what is causing the patient’s problem. As this science improves, it is hoped that this will provide guidance to help doctors choose the most appropriate treatment for a given patient’s condition.

Hahnemann University Hospital | 230 N Broad St, Philadelphia, PA 19102