Ask a top neurologist: what is vascular neurology?

Written by: Professor Hedley Emsley
Edited by: Laura Burgess

Professor Hedley Emsley is one of only a few UK neurologists with expertise in vascular neurology as well as general neurology and we were fortunate to ask him all about his specialty, including all of the conditions that he treats in his practice at the Greater Lancashire Hospital in Preston.

Model image of a brain

What is vascular neurology?

Vascular neurology is concerned with neurovascular conditions affecting the central nervous system. This is a large field and encompasses common conditions such as stroke and transient ischaemic attack as well as other types of brain blood vessel disease – or cerebrovascular disease – such as cerebral small vessel disease.

Prevention of recurrent stroke depends, in part, on the accurate identification of the underlying cause. This will often be arterial disease such as ‘hardening’ or atherosclerosis, or a heart rhythm problem such as atrial fibrillation, but there are many other causes particularly in younger adults including cervical arterial dissection.

The cause of some strokes will remain unknown despite extensive tests – these are known as cryptogenic. A small proportion of strokes are due to thrombosis involving the veins, a condition known as intracranial venous thrombosis.

Neurovascular conditions include a large number of other disorders such as subarachnoid haemorrhage in which blood leaks beneath the arachnoid membrane of the brain from a major blood vessel. This can be due to trauma or may be spontaneous due to an underlying intracranial aneurysm.

Other conditions include arteriovenous malformation where there is an abnormality of the blood vessel network in which arteries and veins become joined in a haphazard manner. Another type of malformation of blood vessels is a cavernoma, which often form a small round cluster of abnormally enlarged blood vessels.

Conditions such as subarachnoid haemorrhage and arteriovenous malformations are often managed jointly with specialists in neurosurgery and interventional neuroradiology. A variety of other disorders are managed by vascular neurology including cerebral vasculitis where there is inflammation of the blood vessels of the brain.

What more can you tell us about cerebrovascular disease?

Cerebrovascular disease can also show itself as late-onset epilepsy, which is known to be associated with an increased risk of stroke. Late-onset epilepsy can be difficult to diagnose because seizures occurring later in life, typically focal seizures, can be more difficult to recognise and distinguish from other causes of transient neurological dysfunction such as transient ischaemic attack, migrainous aura, and the more recently recognised amyloid spells of cerebral amyloid angiopathy.

Interest is growing in cerebrovascular disease because of its role in other neurological conditions such as parkinsonism, including vascular parkinsonism which is usually due to small vessel disease, and idiopathic Parkinson’s disease, where there appears to be an interaction between blood vessel disease and the neurodegenerative process, as well as in dementia, including Alzheimer’s disease, vascular dementia and mixed dementia.

Professor Emsley specialises in treating stroke, cerebrovascular disease, epilepsy, migraine and neurological disorders. You can book an appointment to see him via his Top Doctor’s profile here.

By Professor Hedley Emsley

Professor Hedley Emsley is a renowned consultant neurologist practising privately at the Greater Lancashire Hospital in Preston and BMI The Lancaster Hospital in Lancaster. His areas of expertise include vascular neurology, stroke, cerebrovascular disease, late-onset epilepsy, migraine and neurological disorders.

Professor Emsley graduated with an MBChB in 1996 from the University of Manchester. He undertook several junior doctor posts in the North West of England and at the National Hospital for Neurology and Neurosurgery in London before becoming a member of the Royal College of Physicians of London (MRCP) in 1999. He then completed a PhD on inflammation and cytokine regulation in stroke and undertook specialist training as a clinical lecturer in neurology at the Walton Centre for Neurology & Neurosurgery in Liverpool. Before becoming a fellow of the Royal College of Physicians of London (FRCP) in 2012, he obtained both the Certificate of Completion of Training (CCT) in neurology and a postgraduate certificate in clinical education in 2008 (PGCTLCP with distinction).

Professor Emsley was appointed Consultant Neurologist with special interest in Stroke Neurology at Lancashire Teaching Hospitals NHS Foundation Trust in 2008, and in 2014, he  became the Clinical Director for Neurology at the Trust for three years. He has several other professional responsibilities including his roles as a co-chair of the Association of British Neurologists Stroke Advisory Group and clinical advisor to the Neurology Intelligence Collaborative. He was also the external examiner for the University College London Stroke MSc programme until recently.

He took up his post as Professor of Clinical Neuroscience at Lancaster University in 2017 alongside his NHS role. He has published over 100 publications in peer-reviewed medical journals and regularly engages in peer-review and editorial work. Furthermore, he serves on the North West National Institute for Health Research (NIHR) advisory panel for the Research for Patient Benefit (RfPB) scheme and is a chief investigator and a research supervisor on a range of NIHR portfolio studies in stroke and neurological disorders.

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