Awardee: Emanuele Spina, MD, Neurology Specialist and PhD Fellow – University of Naples “Federico II” –
Department of Neuroscience, Reproductive and Odontostomatology

Host Institution: Inselspital Bern, Neurology Department, Bern, Switzerland

Period of Visit: 18th October – 5th November 2021

Firstly, I would thank the European Stroke Organization for allowing me to live this wonderful experience and the Neurology Department of Inselspital for accepting my application.

What an experience!

During the external rotation of my residency, which finished in 2019, I could get the first contact with vascular neurology, not having an emergency department at my Academic Hospital. Then I continued my training on my own, trying to improve my skills as a vascular neurologist and as a neurosonologist in my Department and during short working experiences in non-academic hospitals in my Region.

During the weeks at Inselspital, my main goal was to capture the decision-making process of the Stroke Team, and to steal some tips to apply to my daily routine once came back. Furthermore, to put my new knowledge in the development of a Stroke Unit at my Academic Hospital and to hand it over to residents of my School of Neurology.

I expect that this period of internship in Bern will be crucial in my professional path. During time spent there I had the privilege to assist and discuss a great variety of clinical scenarios and a large number of stroke patients.

Inselspital is the place that each vascular neurologist imagines in his dreams: my daily routine was made of early morning hours spent in the emergency department waiting for a wake-up stroke; then to the ward round in the Stroke Unit, discussing and visiting each patient admitted (and mostly yet known, because welcomed at the emergency department in the day before) and then to the ultrasound lab where despite I routinely perform ultrasound examinations in my Hospital, I could learn new techniques and the correct setting of each neurovascular doppler examination. Surely this will help me improve the quality of my exams and give me the possibility to guarantee better care to my vascular patients.

Every step of this path had its peculiarity: the emergency department, which welcomes patients directly from emergency territorial services or from peripheral stroke units able to perform only intravenous treatments, is the place where I had the chance to learn what was the process to decide whether and how to treat acute stroke patients; conversely, the visit round in Stroke Unit is the moment in which, by re-discussing the imaging (mainly MRI) and the peculiar features of each patient, we tried to state the exact mechanism of the stroke to provide the best secondary prevention therapy. Furthermore, in Stroke unit skilled paramedical team guide patients through the very early phase of rehabilitation; lastly the ultrasound lab represents a key place in the
process of discovering the possible causes of strokes and in patients’ long-term follow up. Moreover, during these three weeks, I was able to assist directly in the angio-suite four thrombectomies. It was surprising how interventional neuroradiologists were so engaged in explaining to me each part of the procedure!

Concluding, it was impressive the importance given to theoric education granted to residents: each week took place the neurovascular board in which each resident can discuss a case of particular interests; moreover, on Tuesday afternoon neurologists of peripheral stroke units could ask the neurology team of Bern how to manage challenging cases. Lastly, once a week, residents could follow in-site seminars about various neurological diseases.

The richness of this experience, nevertheless, was not made up of only neurovascular concepts. What I witnessed was a highly organized staff, not only regarding supervisors or residents but also concerning the entire system of stroke care. From nurses to physiotherapists, from neuropsychologists to logopedics, everyone knows what to do and did it in the best way possible, resulting in a higher chance of a good outcome for patients.

But I had not only professional enrichment; from a personal point of view, I found a team with a great willingness to teach, available to translate any discussion in English, and with always an answer to my thousands of doubts. My welcome was very warm: I had never been left alone in my time at the hospital because in every moment I found someone available to answer my doubts and to discuss challenging cases.

My main aim, once at home, will be to export the model of stroke assistance seen at Inselspital in my Hospital, where the project is to create a Stroke Unit of the second level deeply involved in stroke treatment in my Region. Not of less importance will be the process of handing over to the residents of my School of Neurology, that must become skilled to train properly acute stroke patients in our territory.

I am grateful to the Stroke Team of Inselspital, Bern, for sharing with me their knowledge on vascular neurology, hoping to take advantage of it to serve my country the best as possible!

Naples, 8th November 2021