Neurocritical Care

Wesley Medical Center’s 14-bed state-of-the-art Neurocritical Care Unit is located within the hospital’s Surgical Intensive Care Unit and is for patients suffering from an injury or disease of the nervous system (brain, spine or nerves).

The unit includes wired-in EEG capabilities, cameras for safety, and monitoring for epilepsy, intracranial pressure, cerebral perfusion pressure, cerebral blood flow and brain temperature. It also provides brain oxygen measurement and the ability to maintain targeted temperature, along with other ICU monitoring capabilities. The unit is open 24/7 and staffed with all board-certified medical staff.

Laxmi Dhakal, MD

The region’s only neurocritical care fellowship-trained physician. Board-certified in psychiatry and neurology (ABPN) and neurocritical care (UCNS), Dr. Dhakal completed a fellowship in neurocritical care with the Mayo Clinic. He has been involved in extensive clinical neurologic research and published in leading medical research journals. He also served as a clinical assistant professor for the Neurology Department and Department of Internal Medicine at Kansas University. Dr. Dhakal is the medical director of Wesley’s Neurocritical Care Unit.

Dr. Dhakal

Examples of injury or conditions of the nervous system that are life threatening or could lead to disability include:

  • Traumatic brain injury (TBI): A hard bump, blow or jolt to the head or penetrating head would that disrupts the normal function of the brain can cause TBI. TBI is an emergency and lead to impaired thinking, movement, vision and hearing, as well as depression and personality changes. Our team works quickly to limit damage, and may use medications to reduce pressure on the brain, prevent seizures and, if needed, cause a temporary coma to help the brain heal. Emergency surgery may be needed to remove a blood clot, repair a skull fracture or open a window in the skull to release pressure on the brain.
  • Spinal cord injury (SCI): A traumatic injury to the head, neck, chest or back can cause a spinal cord injury. Other causes can include electrical shock or extreme twisting of the body. SCI can lead to permanent paralysis and other serious health problems, and needs to be treated right away to help reduce permanent damage. Medicine called corticosteroids can reduce swelling that may damage the spinal cord. Emergency surgery may be needed to realign the spine, reduce pressure on the spinal cord and nerves, remove bone fragments or other objects, fuse broken spinal bones or place spinal braces.
  • Stroke: A stroke must be diagnosed and treated quickly (within three hours) to give you the best chance for recovery and to limit damage and resulting disability. Simply taking one aspiring per day can prevent another stroke, and clot-busting drugs can dissolve a blood clot causing a stroke. Emergency surgery and other procedures may be needed to stop bleeding and save brain tissue.
  • Ruptured aneurysm: An aneurysm is a balloon-like bulge of an artery wall. As it grows, it puts pressure on nearby structures and may eventually rupture. A ruptured aneurysm releases blood into the spaces around the brain, a life-threatening condition called a subarachnoid hemorrhage. Threatment focuses on stopping the bleeding and repairing the aneurysm as quickly as possible.
  • Seizure: A seizure is a medical emergency if it lasts five minutes or longer, or if you have several seizures and do not wake up between them. Some medications can help stop a seizure, and our team will monitor you and help keep you safe during and after a seizure.
  • Brain tumors. Brain tumors, whether cancerous or noncancerous, need prompt, specialized treatment to give you the best chance for recovery and healing. Our specialists are leaders in treating brain tumors and caring for you after treatment.
  • Encephalitis (infection of the brain). A virus or bacteria can cause encephalitis, and severe cases need immediate, specialized treatment. Medicines can help you reduce inflammation and fight the infection, and you may need artificial respiration if you are having problems breathing.
  • Meningitis (infection of the thin membrane around the brain or spinal cord). A virus or bacteria can cause meningitis. Early treatment can help prevent serious problems and even death. You may be given antibiotics or antiviral drugs, fluids, and medicine to reduce brain swelling, shock or seizures.

Neurodiagnostic Services

Wesley’s neurodiagnostic lab provides inpatient and outpatient testing to diagnose disorders of the brain and nervous system. Testing procedures can be tailored to meet the specific needs of each patient. Our medical center is equipped with the most state-of-the-art technology and procedural equipment to ensure the highest quality of care possible and meet national standards.

  • EEG – an EEG records the brain’s electrical activity, using electrodes that are placed on the patient’s scalp. The test is not painful and takes about 90 minutes with the patient remains still and relaxed. The patient may be asked to take repeated deep breaths and may be shown a strobe light that flashes at different speeds. Both activities can help reveal different brain patterns that help doctors to make the correct diagnosis.
  • EP – an EP is a digital recording of electrical activity from the brain, spinal nerves or sensory receptors in response to a specific external stimulation. After electrodes are applied to the scalp and other areas of the body, a series of stimuli is introduced and a computer records the neurological responses. An EP is helpful when evaluating a number of different neurological problems, including spinal cord injuries, acoustic neuroma and optic neuritis.
  • AEP – an AEP assists in evaluating the auditory nerve pathway from the ears through the brainstem. Electrodes are attached to the scalp and earlobes, and earphones are placed over the ears. The earphones deliver a series of clicks or tones to each ear separately.
  • Visual EP – a VEP evaluates the visual nervous system from the eyes to the occipital (visual) cortex of the brain. Electrodes are applied to the scalp, and the patient is usually asked to stare at a pattern on a video screen while remaining fully alert. Each eye is tested separately.
  • SSEP – a SEPP assesses pathways from the nerves in the arms or legs, through the spinal cord to the brainstem or cerebral cortex. After electrodes are placed on the scalp and along the spinal cord, a small electrical signal is applied to the skin overlying nerves on the arms and the legs. This current creates a tingling sensation that is not painful. Each leg or arms is tested separately.
  • Long-term EEG with video monitoring – long-term monitoring is the simultaneous recording of EEG and videotaped behavior over extended periods of time. It is helpful in diagnosing patients with intermittent or infrequent disturbances. These lengthy tests are performed in the lab, using special computers.