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CLINICAL SERVICES & FACILITIES
» Adult Neurology
• In-Patient Service
• Consultations
• Ambulatory Care
» Pediatric Neurology
» Diagnostic Services
» Harlem Hospital Center
» Neurological Surgery
» Neuroendovascular Service
Adult Neurology
In-Patient Service
The NI supports one of the most active neurology services in the country. Neurology beds are located in the Milstein Hospital Building (MHB), which opened in 1989. The daily census averages 55 patients, and in 2005, about 2,250 patients were admitted. Approximately 60% of patients are admitted electively by attending physicians; the remainder are admitted from the emergency room and clinics. Neurology and Neurosurgery share 76 beds on the 8th floor, as well as 18 beds in a separate, dedicated Neurological ICU (NICU) equipped with on-site 3T MRI, CT scan, advanced electro-physiological monitoring, and other state-of-the-art equipment and capabilities. Other inpatient facilities include a Neurovascular Unit and a separate video-EEG Epilepsy Monitoring Unit (8 beds). All of these neurological in-patient services are located on the 8th floor, creating in effect a "hospital within a hospital." Neurology patients involved in research protocols are admitted to the Irving Clinical Research Center. Rehabilitation Medicine and Psychiatry administer separate 41 and 15 bed units, respectively. Residents are exposed to a rich variety of patients with common as well as rare neurological conditions. This wealth of clinical experience provides the basis for excellent clinical training as well as opportunities for research.
Consultations
Neurology residents provide consultations each year to about 3,300 adults and 950 children in other parts of the Medical Center.
Ambulatory Care
The Adult General Neurology Clinic meets four afternoons each week in the Vanderbilt Clinic Building. There are also subspecialty clinics for patients with Parkinson disease and other movement disorders, neuromuscular diseases, multiple sclerosis, epilepsy, and memory disorders. The Pediatric Neurology Clinic meets separately one afternoon each week. In 2004, the Adult and Pediatric Clinics provided care for over 8,000 patients. Private outpatients are seen in the Neurological Institute building, but a new Ambulatory Care Center is being planned, where all patients will be seen in a single, payor-neutral setting that is optimally configured to integrate high-quality care, teaching, and clinical research. Residents currently spend two afternoons each week in the clinic and 4-6 weeks rotating in attendings' private offices.
Pediatric Neurology
The Pediatric Neurology Training Program (Interim Director, Dr. Claudia Chiriboga) at Columbia University Medical Center was one of the first in the United States, and Pediatric Neurology has always been a vital division of the Department of Neurology. All inpatients are located in the Children's Hospital. Divisional offices are located on the 5th floor of the Harkness Pavilion. The Pediatric Neurology inpatient service shares a 30-bed ward with Pediatric Cardiology on the 11th floor of the Children's Hospital. In addition, the Service includes four video-EEG monitoring beds, which are part of the Pediatric Epilepsy Section of the Comprehensive Epilepsy Center. Each year, approximately 550 children are admitted to the combined Pediatric Neurology/Neurosurgery Service. Pediatric Neurology residents see about 1,000 consultations annually in other parts of the Children's Hospital and in the Pediatric Emergency Room. The Pediatric Neurology Clinic and Pediatric MDA clinic record about 2,500 visits each year, while faculty attendings see another 3,000 patients annually. The volume and variety of patients seen affords residents the opportunity to participate in the diagnosis and management of the complete range of nervous system disorders in children. Teaching sessions specific to child neurology are held two or three times weekly, and residents participate actively in the development and evolution of the curriculum. More formal evening seminars are held each month during the academic year, and these attract pediatric neurologists from the entire New York metropolitan/ tristate area, providing a lively and enjoyable forum for case-based discussions.
Diagnostic Services
The Neurological Institute supports a variety of diagnostic services. Each year, neuroradiology (Director, Dr. Robert DeLaPaz) performs over 8,000 studies and 9,000 scans. Clinical neurophysiology includes electroencephalography (4,000 examinations) and evoked potentials (1,800 studies) (Dr. Ronald G. Emerson, Director), as well as electromyography and nerve conduction studies (4,000 studies). In addition, the Comprehensive Epilepsy Center (Director, Dr. Carl W. Bazil) has eight beds for intensive EEG-video monitoring in the Milstein Hospital Building and four dedicated to children in the Children's Hospital. Facilities for neuro-ophthalmology are directed by Drs. Myles M. Behrens and Jeffrey Odel. The Neuropathology Service (Director, Dr. James E. Goldman), located in the College of Physicians and Surgeons, performs about 200 postmortem examinations of the nervous system and examines approximately 1,500 biopsy and 700 cytology specimens each year.
Harlem Hospital Center
Harlem Hospital Center, a 500 bed municipal hospital, has been affiliated with Columbia University's College of Physicians and Surgeons since the 1960s. It serves a community of over 200,000 people, and admits about 20,000 patients annually. The hospital is an important teaching facility for P&S medical students and neurology residents. The Neurology Unit is staffed by interns and residents of Harlem Hospital's Department of Medicine. This is an active neurology service for patients with stroke, convulsive disorders, neurological complications of alcohol and drug addiction, trauma, and neurological disorders related to HIV infection. Neurology residents serve as senior residents on this Unit and provide consultations to other services under the direction of Dr. John C.M. Brust, Chief of Neurology. Bacterial and tuberculous meningitis, HIV/AIDS, and neurosarcoidosis are seen with unusual frequency. In addition, the sociological environment offers important insights into the problems of providing medical care in the inner city. The Neurology Service works closely with a Neurosurgical Unit of six beds. All neurology residents rotate through Harlem Hospital during the first two years of residency.
Neurological Surgery
From its founding, NI has been home to one of the premier academic neurosurgical programs in the United States, and it has trained more residents than any other program in the country. The Department includes 15 full-time attendings under the leadership of Dr. Robert A. Solomon, who succeeded Dr. Bennett M. Stein as Chairman in 1997. All neurosurgery attendings have individual subspecialty expertise which includes vascular malformations, brain tumors, spine and spinal cord disorders, epilepsy surgery, functional neurosurgery including movement disorders, pediatric neurosurgery, skull base surgery and stereotactic neurosurgery. Over 2,250 neurosurgical operations are performed each year. The neurology and neurosurgical services enjoy a close working relationship, particularly in treating patients with brain and spinal cord tumors, intractable epilepsy, mechanical spine disorders, Parkinson disease and other movement disorders, and cerebrovascular diseases. Service consultations from all parts of the Medical Center are usually addressed first to Neurology, which then involves Neurosurgery as appropriate. For further information, visit the Department of Neurological Surgery's website.
Neuroendovascular Service
Neuroendovascular therapy is a minimally invasive approach to treating selected vascular diseases of the brain and spinal cord using specially designed small catheters (some no larger than 1.5mm). Many conditions that in the past required open surgical techniques are increasingly treated from within, rather than outside, the vasculature. Angioplasty and stenting are often options for treating carotid artery stenosis, and platinum coils are increasingly used as treatment of choice for saccular aneurysms. Therapeutic embolization, with or without later surgical resection, can be used to treat arteriovenous malformations. Intra-arterial thrombolysis extends the window for treating acute arterial occlusions. The Neurological Institute has an outstanding group of endovascular therapists. Drs. Sean Lavine (Neurological Surgery) and Philip Myers (Interventional Neuroradiology) are Co- Directors of the Neuroendovascular Service. Dr. John Pile-Spellman is Director of Research. Neurology residents can elect rotations on this service, and discussions are underway to offer post-residency neuroendovascular training to qualified neurologists.
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© 1997 The Neurological Institute of New York Center | 710 W 168th St, New York, NY 10032
Department of Neurology | Columbia University Medical Center | Last updated:
November 10, 2009
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