Faculty and residents see approximately 700 inpatients and 1500 outpatients annually.
The designated neuroscience floor at Allegheny General Hospital has 36 beds dedicated to the care of neurologic and neurosurgical patients, with three rooms designed for extended-stay video-electroencephalography (EEG) monitoring.
The faculty and house staff also monitor 8 maximum-observation beds for trauma/intensive care neurology/neurosurgery patients and 23 beds in the Surgical or Neuro Intensive Care units.
The department diagnostic laboratory capabilities include the EEG/Evoked Potential (EP) Laboratory and Electromyography (EMG)/Nerve Conduction Velocity (NCV) Laboratory, in addition to continuous video-EEG monitoring.
Neurology residents care for patients in the General Neurology Clinic and in subspecialty clinics such as those listed below.
Comprehensive Stroke Center
Allegheny General Hospital was one of the first medical centers in the country and the first in western Pennsylvania to be designated as an Advanced Comprehensive Stroke Center by the Joint Commission. A multidisciplinary team that consists of three board-certified stroke specialists manages stroke at AGH in addition to three interventional neuroradiologists and fully staffed neurosurgery and neurocritical care services.
Neurology residents at AGH manage all aspects of stroke care. Neurology residents are the team leaders in the acute stroke alerts and direct the management of stroke patients in the emergency department, including screening and administration of tPA, advanced imaging, management of complications, reversal of anticoagulation and decisions regarding emergent endovascular procedures. Patients admitted to the stroke service are followed by the neurology residents throughout their hospitalization, which includes being the primary care provider in the neurocritical care setting as well.
Allegheny General Hospital is fully equipped with 3 MRI scanners (1.5 Tesla) with diffusion and perfusion weighted imaging capability, 4 CT scanners (CT angiography and perfusion imaging), digital subtraction cerebral angiography, transcranial Doppler and carotid ultrasound. The hospital also has a 23-bed Neuro Intensive Care Unit, 36-bed Neuroscience Unit and a 42-bed Telemetry Monitored Unit. LifeFlight is the aeromedical transportation system based at AGH and provides rapid transfer of stroke patients to AGH for acute stroke care.
While neurology residents provide care exclusively at Allegheny General Hospital, four other hospitals within the Allegheny Health Network system have primary stroke centers. Complicated stroke, hemorrhages and interventional cases are usually transferred to the Comprehensive Stroke Center at AGH for management, providing neurology residents with an opportunity to be exposed to high-acuity and challenging cases.
The stroke department is also involved in several clinical trials including IRIS, CLEAR III, Clot Lysis, POINT as well as registries such as GLORIA-AF.
Comprehensive Epilepsy Center
The Comprehensive Epilepsy Center at AGH has three attending epileptologists on staff. There is an active epilepsy surgery program with participation of an epilepsy neurosurgeon and neuropsychologist. Neurology residents get significant exposure to the management of seizures and epilepsy via this clinic, but also in the resident continuity clinic, which is usually staffed by one of the epileptologists. There is also a weekly epilepsy surgery conference that the residents are expected to attend.
The EMU at AGH has 4 dedicated beds staffed by a technologist and a nurse. In the neuroscience unit there are an additional 8 beds that are hard-wired and ready to function as EMU beds.
The inpatient neurology service is in close relation to the epilepsy service and significant numbers of consults in the hospital are for seizures and status epilepticus. The EEG laboratory at AGH operates 6 portable video EEG machines and has 4 dedicated technologists. Neurology residents at AGH get a broad exposure to the management of seizures and epilepsy, both in the inpatient as well outpatient settings.
Two neuromuscular specialists perform approximately 1200 EMG studies per year. In the EMG rotations, neurology residents are exposed to a full range of neuromuscular pathology and are directly involved in performing neurodiagnostic studies, along with a fellow, attending and EMG technicians. AGH also has one of the few autonomic laboratories in the region for the diagnosis of small fiber neuropathies and other neuromuscular disorders.
The neurodiagnostic lab also has an outpatient and inpatient EEG service which performs approximately 2300 EEGs per year. About 250 Continuous video EEGs per year are performed. There are 6 portable Natus/Xltek EEG machines operated by four EEG technicians. Routine and long-term EEGs are provided throughout the hospital’s nursing units and critical care units providing neurology residents with exposure to a high variety of EEG findings along the ictal-interictal continuum.
At AGH there is also a full intraoperative monitoring service staffed by two neurologists and nine IOM technicians and residents interested in clinical neurophysiology are welcome to spend elective time in IOM.
MS Clinic and Infusion Center
Two highly experienced multiple sclerosis specialists work on staff. Thomas F. Scott is an internationally renowned expert on CNS inflammatory diseases and has published extensively on neurosarcoidosis, multiple sclerosis and neuromyelitis optica. Dr. Scott also authored the American Academy of Neurology’s guidelines on transverse myelitis. Dr. Scott and Dr. Desai are involved in ongoing clinical trials and have participated in pivotal clinical trials leading to the approval of several MS therapies.
The multiple sclerosis clinic at AGH has a specialized nurse and provides multidisciplinary care through the National MS Society local chapter. Patients with suspected CNS inflammatory diseases undergo comprehensive diagnostic evaluations and neurology residents are exposed to newly diagnosed as well as long-standing care of these patients. AGH also runs an MS infusion center for the administration of intravenous steroids and disease-modifying therapies in the outpatient setting.
Movement Disorders Clinic
All movement disorder diagnoses are represented in this program; subspecialty patient populations include over 3,000 patients with Parkinson’s disease, 250 patients with dystonia, and 100 patients with Huntington chorea.
The deep brain stimulation program includes comprehensive pre-operative evaluation, dedicated intra-operative neurophysiology monitoring, and post-operative management. State of the art stereotactic functional radiosurgery is also available at the center.
Residents get ample exposure to the diagnosis and management of movement disorders and work in close relation to the two subspecialists at this center.
ALS Certified Center of Excellence
Allegheny General Hospital has the only ALS Association-certified center of excellence for ALS in western Pennsylvania. The ALS Clinic is a group of multidisciplinary professionals from neurology, physiatry, social work, speech therapy and pulmonary care who meet regularly to support the ongoing care, diagnosis and therapy of patients with ALS. This allows for comprehensive care in one place at one time. The clinic has treated hundreds of patients and supported their families during the diagnosis and treatment of this disease.
Myasthenia Gravis Clinic
The Myasthenia Gravis Association of Western Pennsylvania is located at Allegheny General Hospital and is a regional referral center for MG patients. Myasthenia Gravis care at AGH includes diagnosis through the Neurodiagnostic Laboratory and various types of therapy, including IVIG, plasma exchange, steroids and immunosuppressive therapy, as well as consideration of thymectomy. Neurology residents get valuable experience managing MG in the outpatient as well as inpatient setting and work closely with the two neuromuscular specialists on staff.
Conferences and Lectures
- A.M. Report, precepted by faculty – Mon, Tues, Thurs
– Combined Neuro/NSG/NPath – 3rd Tuesday
- Epilepsy & Stroke Case Conferences – alternate weekly
- Noon Conferences – 3 days per week
- Board Reviews – weekly
- Grand Rounds – weekly
- Basic Neurosciences – weekly
- Neuropathology lectures – monthly
- Neuroanatomy lectures – monthly
- Journal Club - monthly
- Morbidity and Mortality – quarterly
- Neuropsychology conference – monthly
- American Society of Neuroimaging Teleconference – Every 15 days
- Emergency Room lectures – 2 months per year (once a week)
- Star Simulation Center – Lumbar Puncture experience