For Health Care Professionals

The goal of the Cerebrovascular Disease and Stroke Program is to provide the highest level of care for patients and families dealing with stroke, transient ischemic attack, and other cerebrovascular conditions, including brain aneurysms and vascular malformations.

Inpatient care is provided at the Neuroscience Unit at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire, which includes an eight-bed Neuro Special Care Unit. Our diagnostic capabilities include MRI and MRA, MR perfusion, conventional (digital subtraction) angiography, among other diagnostic tests. Our clinical and research activities include the closure of patent foramen ovale in cryptogenic stroke and carotid artery stenting.

We also provide educational materials for hospitalized patients and their families and develop a curriculum for medical students and house staff.

Please refer to the following information for health care professionals:

  • Cerebrovascular case conference: A weekly interdisciplinary conference that is led by the interventional neuroradiology fellow.
  • Guidelines, order sets and stroke protocols: A list of guidelines, order sets and protocols for stroke conditions.
  • Stroke alert training: Information about our simulation lab mock stroke alert training for neurology residents and emergency department providers.

See how we use a real-life simulation approach to training our staff to improve outcomes for stroke patients and their families:

Cerebrovascular case conference

This interdisciplinary conference takes place weekly and is led by the interventional neuroradiology fellow.

At this meeting, we discuss the treatment planning for complex patients and review cases for quality improvement purposes. It is also an excellent learning opportunity for residents, advanced practice nurses, and fellows.

Recent cases reviewed include complex intracranial aneurysms, dural arteriovenous fistulae, arteriovenous malformations, and thrombolysis.

To submit a case for this conference, please contact one of the program physicians.

When it comes to stroke, minutes matter.
Rapid Access TIA Clinic at Dartmouth-Hitchcock

A Transient Ischemic Attack (TIA) is a major warning. Even though the symptoms go away, the risk does not. Studies show that as many as one-third of TIAs progress to stroke, with the greatest risk in the first few weeks. Rapid assessment and treatment for TIA patients is critical.

Rapid Access TIA Clinic

We’re here for you and your patients when minutes matter.

The Rapid Access TIA Clinic at Dartmouth-Hitchcock (D-H) offers specialty care for TIA patients without the need for a hospital admission or an ED visit. Your patients will be fast-tracked to providers who specialize in vascular neurology and are typically seen within three days of referral. Our comprehensive evaluation includes individualized diagnostic testing as needed, including: same-day brain and blood vessel imaging, cardiac evaluation, selected laboratory testing, and thorough evaluation of vascular risk factors. Patients leave with an evidence-based treatment care plan that is also shared with their referring provider.

Who is eligible:

  • Over age 18
  • Onset of symptoms more than 48 hours ago and less than 2 weeks ago AND experienced sudden, transient symptoms of TIA, including:
  • unilateral weakness (face, arm, or leg)
  • change in speech
  • vision loss in one or both eyes

What symptoms require different care:

  • Ongoing neurological deficit or symptom resolution less than 48 hours ago: evaluate immediately in the ED
  • Current chest pain, difficulty breathing, severe headache, other emergency symptoms: evaluate immediately in the ED
  • Isolated numbness, dizziness, confusion, memory loss, staring spells: refer to general neurology

To refer a patient:

  • Within eDH (D-H’s electronic health record): Place urgent referral to neurology and specify “Rapid Access TIA clinic”
  • Outside eDH: Fax referral to (603) 676-4042, Attn: Neurology Rapid Access TIA Clinic
  • Be sure to include referral request from provider and progress note.

For questions, call: (603) 650-5104

One Medical Center Drive, Lebanon, NH 03756

Stroke Education Outreach

Acute Stroke Continuing Education Available! Download informational letter here (PDF)

Guidelines, order sets and stroke protocols

The following documents provide guidelines, references, order set and protocols that you can use for various types of stroke conditions:

Clinical practice guidelines

Our practice follows the American Heart Association's (AHA) and the American Stroke Association's (ASA) clinical practice guidelines. You can review their clinical practice guidelines on the their websites. If you have additional questions, please call us at the Lebanon Stroke number.

Flowsheets and charts

Stroke protocol

Stroke Alert Training

The Cerebrovascular Disease and Stroke Program offers simulation lab mock stroke alert training for neurology residents and emergency department providers.

The goals of this exercise are to improve:

  • The selection of patients for intravenous thrombolysis
  • The detection of stroke mimics, basic CT scan interpretation, and acute blood pressure management

View a sample video clip of a recent training session.

For more information about this training, please contact Timothy Lukovits, MD.