D2D 2020

Awardee: Marieta Peycheva, Neurologist at the Clinic of Neurology – University Multipurpose Hospital for Active Treatment Saint George, Plovdiv, Bulgaria

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

The visit took place from 1-10 September 2020

First, I would like to say that I am very grateful to ESO and especially to Prof. Urs Fischer for giving me the opportunity to visit the Stroke Center at Inselspital, Bern, Switzerland. Prof. Fischer is involved in many clinical studies related to cerebrovascular disease and is a Co-PI in SWITCH study, ELAN study and SWIFT Direct study. He is also one of the founder of ESO ESMINT ESNR stroke winter school, a highly educative course for young neurologists and neurointerventionalists.

The Stroke Center at Inselspital is part of the Department of Neurology, headed by Prof. Claudio Bassetti and I was keen to take this very important opportunity for me as a neurologist.

This visit was planned in a difficult situation due to the COVID-19 pandemic. However, with the support of Prof. Fischer and PD Dr. Heldner, I was happy to arrive at the Department of Neurology at Inselspital beginning of September. Within 10 days, I was able to visit the Emergency Department, the Stroke Unit, the Neurosonology Laboratory and the Neurorehabilitation Department.

I am extremely impressed by the level of organization and collaboration between the various Units involved in the diagnostic process. Information about the patient comes from the ambulance long before the arrival of the patient. This allows the readiness of the various physicians (neurologists, radiologists, anesthesiologists, neurointerventionalists) and maximum optimization of the diagnostic and treatment processes. Each stroke patient undergoes a MR protocol including angiography and perfusion, to diagnose silent strokes, large vessel occlusions and waking up strokes. I am impressed by the professionalism of the team of Neurointerventionalists led by Prof. Jan Gralla and Prof. Pasquale Mordasini. I was able to see treatment of stroke cases with thrombectomy, treatment of aneurisms and diagnostic of AV malformations. It was very useful for me, as in my country endovascular treatment for stroke patients is not on a good level of organization.

In the Stroke Unit, Prof. Marcel Arnold and his team welcomed me. Prof. Arnold is an expert in the field of vascular pathology and during ward rounds in the Stroke Unit, he pays attention to every aspect of the diagnostic and treatment processes. Patients are investigated for all potential risk factors including PVO, inherited thrombophilia and vascular genetic risk factors. It was very helpful for me to participate in the discussion among neurologists about stroke cases.

In the ultrasound laboratory, I saw different cases – patients with acute stroke, after stenting, patients with artery dissection, AV malformations, stenosis of brachiocephalic artery and intracranial stenosis. This was very interesting for me as I also work in an ultrasound laboratory in my hospital. I updated my protocol for ultrasound investigations and had the chance to see different kinds of vascular pathology.

In the neurorehabilitation department, I saw the early rehabilitation program after stroke. It includes various approaches like physiotherapy, ergotherapy, speech therapy and collaboration with social workers. The team of specialists there is motivated to improve the quality of life of every patient.

I also want to express my gratitude to PD Dr. Mirjam Heldner who supported me during my visit and organized my comfortable stay at the department. Last but not least, I would like to thank all my colleagues that I have had the chance to meet in the department for their warm welcome and for translating all the information into English.

I am convinced that this initiative of ESO helps me to transfer the good practice and level of organization of the Inselspital Stroke team to my hospital.

D2D 2020