Neurologists are highly trained medical professionals who play a critical role in the healthcare system in helping patients of all ages manage their conditions that can affect every aspect of their lives. Each month, NeurologyLive® shines a spotlight on the work of one neurologist, highlighting contributions to their specific field.
A current major global health issue in the field of neurology is stroke, which ranks as the second leading cause of mortality and dementia, because of the significant implications it has for disability among patients.1 Although there are effective treatments available for stroke, there remains a lack of awareness of the symptoms, and prevention measures are not widely adopted. Recent research shows that several patients who experience stroke barely reach the hospital in time for life-saving treatment and often patients do not adhere to prescribed therapies or make the changes to improve their quality of life poststroke. Therefore, this research highlights the urgent need for educational campaigns to increase stroke awareness, prevention, and how to make a timely response to symptoms.2
In honor of World Stroke Day, held October 29, 2023, Laura K Stein, MD, MPH, assistant professor of neurology at the Icahn School of Medicine at Mount Sinai, recently discussed her role as a neurologist in the field of stroke, including caring for patients who experienced ischemic stroke and hemorrhagic stroke. As a stroke clinician, her interests are in clinical care, outcomes in research, and medical education. Currently, Stein, who is also an attending physician at the Mount Sinai and Mount Sinai Queens Stroke Centers, is performing research using large-scale databases to help with understanding access disparities and outcomes in stroke to improve care for patients.
Clinical Facts on Stroke
- Each year, more than 795,000 patients in the United States have a stroke, and about 610,000 of these are new strokes.
- About 185,000 strokes—nearly 1 in 4—are in patients who have had a previous stroke.
- About 87% of all strokes are ischemic strokes, meaning that blood flow to the brain is blocked.
Tsao CW, Aday AW, Almarzooq ZI, Beaton AZ, Bittencourt MS, Boehme AK, et al. Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association. Circulation. 2023;147:e93–e621.
NeurologyLive: What are some of the main responsibilities you have in your role as a neurologist?
I have three main roles as a stroke neurologist at Mount Sinai, all of which are interconnected and informed, and enriched by one other. My first and foremost role, which is why I went into medicine, is to care for patients with stroke. This role involves making acute revascularization decisions in the emergency department, working up stroke etiology and implementing secondary prevention measures in the hospital, and educating and supporting patients and their families in prevention and recovery.
The second is as an educator and mentor. I am one of the associate program directors for our residency program and responsible for leading our medical education track. There is nothing more enjoyable than getting to work with and learn from trainees.
Last, but certainly not least, I am a stroke health services researcher. I am passionate about working to better understand and address disparities in stroke care. My current focus is on regional disparities in stroke thrombectomy systems of care.
Could you describe a typical day in your work as a neurologist?
Very few days are the same, which is part of what I love about my job. On clinical weeks, my day starts with reviewing cases from overnight followed by rounding on patients with and teaching students, residents, and fellows; completing clinical documentation; addressing urgent administrative needs, and preparing for the next day. On nonclinical weeks I try to be as structured with my academic time as possible. I like to start each day with dedicated time for writing and academic work.
I also spend lots of time in meetings with research mentors and collaborators, mentees and trainees, and residency leadership. I have the privilege of attending and participating in frequent academic conferences and training opportunities. I also enjoy getting to precept in the stroke fellows clinic on weeks when I am not on an inpatient clinical service.
What motivated you to pursue a career in neurology, and when did you make this decision?
I would be remiss if I failed to acknowledge that I am the proud daughter of a stroke neurologist who set an incredible example for me of what it means to be a passionate and dedicated physician. Although I enjoyed internal medicine in medical school as well, nothing was as stimulating to me as neurology. Stroke felt like the ideal blend of the things I loved most about neurology, including clinical localization, with the most interesting aspects of internal medicine. I was a PGY-2 when the first positive thrombectomy trials were published, and it was incredible to see patients walk out of the hospital who previously might have been left bed-bound. As a PGY-3 with the opportunity to gain more experience, I realized that I loved the high acuity decision-making and complex medical management stroke patients require, as well as the evidence base that informs this care, and that it was the right fit for my future career.
What do you find most rewarding about your work as a neurologist?
Without a doubt, the most rewarding aspect of my work as a neurologist at Mt. Sinai is the people I get to work with and learn from. I am surrounded by intelligent and passionate students, residents, and colleagues who have similar values about patient care, research, and education. I also get to care for a diverse and rewarding patient population and, in the process, establish meaningful relationships with the many interdisciplinary team members involved.
What are some of the biggest challenges you face in your role?
The biggest challenge I face in my role is ensuring that all patients have equal access to the most evidence-based stroke care. I have no doubt that that challenge is vast enough to sustain a career.
Is there something that you wish more patients and clinicians understood about the field of neurology?
There is so much we can do to help patients with stroke, which goes well above and beyond the transformative acute revascularization therapies we have.
In addition to your work as a neurologist, what hobbies or interests do you have outside of the clinic?
My greatest joy is my 2-year-old son. I grew up an avid tennis player and skier and have a love for the outdoors. I have made sure to enjoy these things with my husband and family while pursuing a career in medicine, and I look forward to continuing to share these interests with my son.
Transcript edited for clarity.
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1. Gandolfo C, Alberti F, Del Sette M, Reale N. Stroke prevention and therapy awareness in a large sample of high school students: results of an educational campaign in the Northern-Western Italy. Neurol Sci. 2022;43(12):6847-6854. doi:10.1007/s10072-022-06372-6
2. Navia V, Mazzon E, Olavarría VV, et al. Stroke symptoms, risk factors awareness and personal decision making in Chile. A national survey. J Stroke Cerebrovasc Dis. 2022;31(12):106795. doi:10.1016/j.jstrokecerebrovasdis.2022.106795