24/7 Dedicated Stroke Team in the Region
The Mischer Neuroscience Institute Stroke
Center is the region’s only on-site, 24/7 dedicated stroke team offering
patients comprehensive stroke treatment around the clock. Neurologists at the center treat more than 2,000 stroke patients
annually, who have early access, through leading-edge research, to potentially
life-saving therapies unavailable elsewhere in the region.
Patients also benefit from the institute's state-of-the-art brain imaging capabilities and Memorial Hermann's Level I trauma center. Our team also sees an equal number of patients in our offices, on an outpatient basis, to prevent first or recurrent stroke or to assist with
Our skilled, multidisciplinary teams of treatment and rehabilitation experts at The Mischer Neuroscience Institute are charged with caring for patients recovering from stroke. While not all patients will need the services of each of these team members, a comprehensive stroke recovery program generally involves the care of numerous clinicians, which may include the following:
Attending or Primary Physician who provides supervision and
care for stroke patients’ medical problems and coordinates treatment plans. He
or she likely will be a neurologist, who specializes in the brain or nervous
Practitioner is an advanced practice registered nurse (A.P.R.N.) who has completed
advanced didactic and clinical education. He or she will work closely with the attending
or primary physician to coordinate a stroke patient’s plan of care.
works closely with patients, their families and the healthcare team
during the initial stages following a stroke. Nurses help stroke
survivors with daily care, such as taking medications, bathing, dressing and
toileting, until they can do more for themselves.
Pharmacist provides prescribed medications and can answer any
Physical Therapist helps patients who may have difficulty walking or using an arm or leg.
The therapist will suggest special exercises and techniques to improve
patients’ muscle control and balance.
Occupational Therapist helps patients perform daily tasks on
their own and learn new, practical skills for everyday life.
Speech-Language Pathologist helps patients improve speech, learn other
ways to communicate and deal with swallowing problems.
Social Worker assists patients and family members in planning ways to deal with
social, emotional or financial problems that may arise during hospitalization.
He or she also may assist in discharge planning.
Dietitian helps plan healthy meals to encourage weight and cholesterol
management, and to meet other dietary needs.
Stroke Coordinator helps patients and family members understand clinical terms and manage
treatment and post-treatment expectations. He or she also communicates with other
team members and coordinates teaching needs.
Transitional Care Coordinator helps patients transition back
into the community and provides connection to community resources for follow-up
Manager is responsible for reviewing admission and discharge plans. He or
she will coordinate both events based on individual patient needs and will
Chaplain helps patients and family members cope with grief,
feelings of loss of control, depression, desire for religious sacraments,
short-term counseling needs and loneliness. He or she also discusses faith
issues with patients and can help contact staff from individual churches or
Neuro Critical Care and Stroke Units
Neurointensivists and experienced mid-level practitioners staff our dedicated 32-bed Neuro Critical Care Unit and 12-bed Stroke Unit, around the clock to provide ongoing intensive care to critically ill patients. We manage more neurotrauma cases than any other center in the southwestern United States, and we are internationally recognized for the treatment of high-acuity brain and spinal cord injuries.
tPA Quality Record
Working closely with the Houston Fire Department and local EMS services, the Stroke Center's team has an impressive track record of success in the administration of tPA, the only FDA-approved treatment shown to improve outcome in stroke patients.
25 percent of patients who present with ischemic stroke receive the drug; that is more than 10 times the national average of 2 to 3 percent for tPA administration. Because 80 percent of strokes are caused by cerebral thrombosis, the tPA advantage is an important one.
Using advanced MRI and CT imaging, the Stroke Center's team has the capability to thread tiny catheters into the arteries of the brain to extract the clots causing strokes. This approach allows for reversal of damage in patients who arrive too late for intravenous tPA but within eight hours of symptom onset.
Imaging Studies and Other Tests for Stroke
While physical examination helps
physicians determine the type of stroke suffered by a patient, other tests can
provide more detailed information regarding treatment. Our
stroke team can precisely identify, localize and determine the cause of strokes
and other brain lesions using advanced MRI and CT techniques, and can then
determine whether treatment will benefit or harm the individual patient.
also world leaders in the use of ultrasound both to diagnose and help dissolve
the blood clots that cause most strokes.
Some common tests include:
Tomography (CAT Scan)
A CAT, or CT, scan uses
a computer system to give a detailed picture of brain tissue. This test
can determine whether a stroke was caused by bleeding in the brain or a
blood vessel blockage. When available, a CT scan typically is one of the
first tests performed on stroke patients. During the test, the patient
lies on a table with his or her head in a large, donut-shaped machine that takes pictures of the brain. A CT scan generally takes approximately
15 minutes to complete and is painless.
Resonance Imaging (MRI)
An MRI uses a large
magnetic field and radio waves to give physicians a 3-D picture of the brain.
During an MRI, which is painless, a patient must lie still within the MRI
scanner for approximately 30 minutes. Because the MRI provides such a sharp
image of the brain, it is especially useful in identifying smaller strokes.
of the Carotid Arteries (Doppler)
A Doppler ultrasound
allows physicians to view the primary neck arteries and any blockages or
narrowing due to atherosclerosis. During the test, a technician slowly moves a probe
around the outer surface of a patient’s neck. This probe gathers detailed
information and sends it to a computer for analysis. This ultrasound takes
approximately 45 minutes to complete and is painless.
A physician performs a
lumbar puncture, or spinal tap, to obtain a sample of the normally clear fluid
that circulates around the brain and spinal cord. A doctor generally does this
procedure at the bedside with the patient lying on his or her side. The healthcare
team will inject local anesthetics in the lower back and then insert a thin
needle to gather cerebrospinal fluid. As headaches may arise following the
test, patients are encouraged to drink plenty of fluids and ask their nurse for
pain medication, if needed.
During an echocardiogram,
a technician slowly moves a probe over the surface of the chest to gather pictures
of the heart. This procedure helps the
healthcare team evaluate the size of a patient’s heart, the condition of the
heart valves and the motion of the heart wall. The test takes approximately one
hour to complete and is painless.
provides physicians with an even more accurate view of a patient’s heart. To perform
the test, the healthcare team provides medication to relax the patient and numb
his or her throat, then asks the patient to swallow a probe. This test can
gauge the severity of certain
valve problems and help detect infection of the heart valves, certain
congenital heart diseases – such as a hole between the upper chambers of the
heart, known as atrial septal defect – and a tear or dissection of the aorta.
An EKG produces an image
of the heart’s electrical activity. To perform the test, a
technician places wires on the surface of a patient’s chest and limbs. This test
takes approximately 10 to 15 minutes and is painless.
An EEG is a painless test
that takes approximately 45 minutes to complete and records the electrical
activity of the brain. The healthcare team will measure a patient’s head and
place electrodes on the scalp in preparation for the test. During the test, the
patient will be asked to take several deep breaths and may be shown a strobe
light that flashes at different speeds. Physicians also may want to observe
brain patterns that occur during sleep. An EEG helps physicians diagnose a
variety of neurological problems, including common headaches, dizziness,
seizure disorders, strokes and degenerative brain disease.
Angiography or Arteriography
During this procedure,
the healthcare team injects special dyes into the blood vessels of the head and
neck. The dye in the blood vessels shows up on X-rays and indicates the size
and location of any blockages. A physician generally will perform this test
only if a patient is having surgery such as a carotid endarterectomy to remove
the blockage, or if other tests have not provided sufficient information.
The MNI Telemedicine Program
The MNI Telemedicine Program improves patient access to emergency neurological care by providing them with access to medical consultation in their own communities. Through remote presence robotic technology, the program provides protocol-based care quickly, efficiently and affordably, offering emergency physicians another set of eyes to examine patients.
Hospitals in the MNI Telemedicine Program are linked to the full range of resources offered at Memorial Hermann-Texas Medical Center, providing patient access to medical consultation and emergency neurological care in their own communities. Through remote presence robotic technology, the program provides protocol-based care quickly, efficiently and affordably, offering emergency physicians another set of eyes to examine patients.
The road to recovery following
a stroke will vary depending on the extent of the stroke. During the hospital
stay, patients may be evaluated by physical, occupational and speech therapists
to determine their rehabilitation needs. A physiatrist (physical medicine and
rehabilitation physician) may also be consulted by the attending team to determine
a patient’s rehabilitation needs. Some patients may be able to return home with
home health or outpatient therapy while others may require a long-term,
acute-care hospital stay (LTACH), inpatient rehabilitation or a skilled nursing
facility (SNF). A case manager or social worker will be available to review the
discharge plan prior to discharge from the hospital.
At the Mischer
Neuroscience Institute, the patient’s healthcare team will develop a
comprehensive rehabilitation plan to address the most common initial needs of stroke
survivors. The team will provide training in assisted mobility – or the ability
to sit up, maintain balance, stand and walk – and will provide techniques for
combating spasticity. These professionals also assist patients with activities
of daily living and provide skills training to help facilitate self-dressing,
self-grooming, light meal preparation and independence.
rehabilitation, physical therapists will employ a range-of-motion program for
stroke patients so that stiffness and spasticity are less problematic. A speech
therapist will address any abnormal speaking or swallowing issues and provide
compensatory strategies to avoid aspiration. Similarly, physicians will assess
patients’ cognitive function during rehabilitation and provide treatment and
education on medication management, as needed.
Upon discharge, stroke
survivors may be recommended to the Neurorehabilitation Program at the Mischer
Neuroscience Institute, which offers comprehensive inpatient services,
state-of-the-art technology and innovative therapies and techniques. In the
program, patients will receive an individualized treatment plan to reach
Our staff of stroke rehabilitation specialists
continues to research new approaches to treatment, including constraint induced
movement therapy (CIMT) following sub-acute stroke. Based on the forced use of
affected extremities, CIMT enables other areas of the brain to compensate for
lost neurological function. Other novel methods to promote stroke recovery and
treat spasticity caused by stroke are also employed.
Stroke survivors also
have access to care at TIRR Memorial Hermann, recognized for 23 years as one of
America’s “Best Rehabilitation Hospitals” by U.S. News & World Report. The Stroke
Rehabilitation Center at TIRR Memorial Hermann is specially designed to
maximize an outcome for patients who have suffered a stroke.
from stroke does not end with a patient’s discharge from the inpatient program.
Rather, recovery continues long after the return home. Memorial Hermann offers
outpatient rehabilitation locations throughout the greater Houston area for
patients who require additional treatment and need access to specialized
The Stroke Center at MNI consistently exceeds benchmarks for stroke treatment and is a leader in care delivery and research and innovation. The following is a snapshot of our quality data for stroke care.
- Unruptured cerebral aneurysm clip or coil: 0% mortality rate for 14 months
- Carotid Endarterectomy: 0% mortality rate and 0% post-op strokes from July to December 2012
- tPA treatment rate: 98% of eligible patients received IV tPA over the last 13 months
- tPA treatment time: 40% of eligible patients receive IV tPA within 60 minutes of arrival
- Door to CT time: 90% of patients go from door to CT in 45 minutes (benchmark is 45 minutes)
- Interventional Radiology: Extremely low endovascular complication rate (0.04% for 244 cases)
Appointments and Referrals
To make an appointment or refer a patient, please call (713) 704-7100