Stimulating and eye-opening! If I were to neatly describe my experience at Innsbruck Hospital in Austria, this would be it.

Neurology consultants at Innsbruck Medical University Hospital. (Left to right) Bettina Pfausler, Heena Narotam Jeena, and Martin Sojer.

I am deeply indebted to the World Federation of Neurology and Austrian Neurology Society for providing me with the opportunity to take part in this African Initiative project. My gratitude extends to Sophia Huppmann (social secretary of the Austrian Neurology Society) for tirelessly coordinating the logistics of my stay and to the consultant neurologists Michael Knoflach, Martin Sojer, and Bettina Pfausler for their hospitality and for ensuring I gain the most from my time in and out of the hospital in Innsbruck. Lastly, to my home institution of Tygerberg Hospital and my colleagues, thank you for affording me the time away from work in order to pursue this opportunity.

From the moment I peered through the aeroplane window upon our descent into Salzburg, marveling at the view of the rolling green hills, snow-capped Alps, and scattered village-like dwellings, I knew a unique and enriching experience was about to unfold.

I landed the evening in Salzburg and took the train to Innsbruck the next morning. It did not take me long to realize that I was, for all intents and purposes, functionally aphasic and that my German needed some work. I invested more time into learning the language, and on my first morning at the hospital could thankfully access some basic necessities with ease: “ein große americano, bitte!” (one large americano, please!).

The Innsbruck Medical University.

Every morning I would kit up and brace the refreshing cold air as I walked a short distance of 1 km to get to the hospital. The neurology division at the hospital consists of four wards (stroke unit, general neurology, epilepsy, and intensive care unit).

I spent my first two weeks in the stroke unit, where I was exposed to a multitude of stroke cases. I witnessed impressive door-to-needle times and had first-hand exposure to the day-to-day running of the unit. I quickly realized that access to direct oral anticoagulants and administration of intravenous heparin was easily accessible and formed part of standard practice; warfarin is not routinely used. MRI brain and Doppler of the neck vessels is the investigation of choice for stroke aetiology workup, and this is sometimes followed by angiography and FDG-PET, where indicated. The European guidelines are followed when evaluating the ultrasonography findings to make a decision with regards to management.

The health care worker to patient ratio is impressive, and access to diagnostic tests is readily available. An electronic recordkeeping system, which instantly uploads test results, diagnostic images, and patient notes, is used. Each staff member is equipped with a mobile telephone to use for communication within the hospital, as well as to contact external hospitals and patient family members. Each ward has a secretary who is responsible for arranging the relevant diagnostic tests as well as assisting with administration related to patient care.

View of Innsbruck from the top of Arzler Alm in Innsbruck.

I also spent time in the outpatient department and was exposed to various specialised clinics such as the Huntington’s clinic, ataxia clinic, Parkinson’s clinic, and botulinum toxin clinic. The Medical Emergency Department was another favorite place of mine to visit. Here, I would join the neurology resident and consultant as they attended to various neurological cases, including headache, backache, seizures, and strokes, to name but a few examples.

My last two weeks were spent in the neurology intensive care unit. The team of consultants managing the unit are neurointensivists, and residents spend part of their training time learning to manage critically ill neurological patients. These patients may, however, also have multiorgan involvement and co-management with other disciplines.

All in all, my experience at the Innsbruck Medical University Hospital has been excellent. The partial language barrier has been to my benefit — I was forced to really look at the patients, their body language, and clinical signs and listen to the prosody of their speech in order to gain an understanding of their impairments. In neurology, we can learn so much through observing our patients. I trust that the exposure to a broad spectrum of neurological disease will prove to be beneficial to my future practice in the field. Furthermore, the opportunity for personal growth which this experience has afforded me is far-reaching.

As the adage goes, all good things must come to an end. I look forward to the next part of my journey where I am able to offer greater insight and expertise into the management of patients with neurological disorders. The relationships that have been fostered with experts in the field are invaluable, and we are already exploring avenues with which to facilitate continuous education, research, and collaboration in the near future. Ending my stay with a stimulating and engaging meeting with Prof. Wolfgang Grisold, WFN president, has reawakened the advocate inside me and reminded me that kindness and humility are the highest accolades to strive toward. •

Heena Narotam Jeena is a registrar in the division of neurology at Tygerberg Hospital/University of Stellenbosch in Cape Town, South Africa.

Visit for a young Nigerian neurologist: a generosity beyond measure

By Daniel Ekhaeyouno Ezuduemoih

Dr. Ezuduemoih with Marco Medina, WFN co-opted trustee, and Wolfgang Grisold, WFN president in Dr. Grisold’s office in Vienna.

Taking an academic voyage in medicine as a student and then a resident in neurology in a densely populated country like Nigeria with a teeming number of patients with neurological diseases has come with its own two sides of the same coin: one with knowledge-based learning driven by experienced teachers in a technology disadvantaged setting, where some neurological diseases are attributed to cultural causes for want of a better explanation. Honing one’s clinical skills in this setting and the desire to continuously improve oneself quickly became a non-negotiable requirement. Learning was made worthwhile by being blessed and mentored by seasoned tutors whom themselves have extensive clinical experience from many years of practice.

My training center, Lagos University Teaching Hospital, designed the neurology residency to accommodate a variety of seminar presentations, didactic sessions, and learning opportunities. Despite these opportunities for learning, the urge to see how things are done in a more advanced setting sprang from a deep-seated craving yearning for fulfillment. I applied as soon as a position for a department visit to the Austrian Neurology Department became available, so I could see how the system works. Fortunately, I was selected.

On arrival in Vienna, I boarded a train to Salzburg, where I would start my posting cum observership the next day in the neurology department of the Christian Doppler Clinic with my designated mentor, Prof. Eugen Trinka, a pleasant, joyful, and highly regarded epileptologist. Dr. Giorgi Kuchukhidze and the department’s secretary, Christa Muller were on hand to welcome me the next morning. They walked me through the paperwork and showed me around Salzburg’s facilities and the surrounding areas.

I was more than thrilled to be able to participate in daily morning reviews of patients from the prior day’s call duty. Dr. Bosque Pilar, a Spanish PhD student in epilepsy, was always willing to translate German into English for me. Every morning, I looked forward to this meeting not only for its rich educational substance but also for the show of genuine patient empathy. Everyone welcomed me with open arms. I witnessed timeliness, orderliness, team spirit, and astute attention to duty in all ages. Doctors, nurses, and other support staff worked well together.

Dr. Susanne Grinzinger, who specialized in NCS and EMG, and her resident, Dr. Bernadette Wigand, would take turns explaining the fundamentals of NCS and EMG to me during nerve conduction and electromyography sessions, and they made the process seamless. On weekends, she would give me textbooks to study NCS and EMG. My gratitude is indeed beyond words.

Drs. Markus Leitinger, Kalss Gudrun, Fabio Rossini, and other staff members of the epilepsy unit assisted me. I witnessed first-hand the use of video electroencephalography to monitor patients and received instructions on how the procedure operates and guidance on EEG interpretations. I would get explanations from Dr. Leitinger, who had a specialty in evoked potentials, on the concept and how to interpret this in a clinical setting.

Dr. Ezuduemoih with Marco Medina, WFN co-opted trustee, and Wolfgang Grisold, WFN president.

The acute stroke unit served as an example of the benefits of teamwork and the blending of various disciplines. Here, all patients were connected to centrally transmitting monitors, allowing for the monitoring of all patients from one place. Dr. Slaven Pikija showed me around various departments, including the emergency room, where paramedics and community doctors at the ambulance unit would communicate the patient’s condition and diagnosis to the hospital over an intercom. I also took note of the triage processes, which assigned each patient to a unit based on their state of consciousness and potential diagnoses. The point-of-care services provided here were excellent. We also briefly visited the well-equipped Neurorehabilitation Center built to meet every individual patient’s needs.

Finally, I am grateful for the mentorship of my teachers at the neurology unit at Lagos University Teaching Hospital, Professors Frank Ojini, Njideka Okubadejo, and Drs. Oluwadamilola Ojo, Osigwe Agabi, and my immediate senior colleague, Dr. Uchechi Agulunna.

Maya Angelou sums up my experience with the words: “This is a wonderful day. I have never seen this one before.” Indeed, it was an exceptional exposure to kindness beyond limits and the Austrian Neurological Society’s desire to make the world a better place. I have truly never seen it before. Thank you, the Austrian Neurological Society, I am forever grateful! Thank you, the World Federation of Neurology for your selflessness. The world is certainly a better place because of you all.

Ich schlafe jeden Tag und träume von deiner Freundlichkeit, die Tiefe meiner Dankbarkeit ist unbeschreiblich.  Danke nochmal. •

Daniel Ekhaeyouno Ezuduemoih, MBBS (Benin), MWACP (Intl Med) is a senior registrar in the neurology unit at Lagos University Teaching Hospital in Nigeria.

By Prisca-Rolande Bassolé

Prisca-Rolande Bassolé

I am Dr. Prisca-Rolande Bassolé, neurologist from Dakar, Senegal. I would like to thank the World Federation of Neurology and the German Neurological Society for giving me this great opportunity to visit the department of neurology, Nov. 21-Dec. 16, 2022, at Universitätsklinikum Leipzig.

I was warmly welcomed since I arrived at the airport by Prof. Joseph Classen, department head, who introduced me to the staff the first day. He arranged weekly rotational visits for me.

Week 1: Stroke and neurointensive care unit

During my first week, I had the opportunity to attend the twice-daily rounds.  I was able to observe the quality of the multidisciplinary medical and nursing care of patients who had undergone thrombolysis, who were awaiting further examinations or who were being investigated for the etiological diagnosis of acute paroxysmal neurological symptoms. I especially remember the clinico-electrophysiological management in the context of the diagnosis of a very acute onset of Guillain-Barre Syndrome, which was thus able to benefit from plasmapheresis.

Left to right: Prof. Joseph Classen (Head of Department), Prof. Petra Baum, Dr. Prisca-Rolande Bassolé, Prof. Dorothée Saur, Dr. Caroline Awiss, Dr. Daniela M. V. Kuenheim, and Dr. Christoph Mühlberg.

Week 2 and 4: Functional Diagnosis Unit

In my two-weeks of observation in this unit, I had the opportunity to observe Doppler and Duplex sonography of intra- and extra-cranial arteries. I also observed the exciting botulinum toxin injection sessions. I took part in the rewarding sessions of discussion and interpretation of neurophysiological tests (EP, EEG, EMG, and nerve conduction). I also attended consultation on movement disorders, and I had the great opportunity to attend a deep brain stimulation surgery. I particularly enjoyed my time in this unit. Prof. Petra Baum gives her time for each member of her team and is patient and didactic. Thanks to Prof. Baum and all members of her team (Daniela, Caroline, Clément, and Christoph).

Week 3: Emergency room (ER)

During my stay in the ER, I was particularly impressed by the implementation of the “Time is Brain” theory. I saw how acute stroke is managed from arrival to treatment with thrombolysis or thrombectomy. Neurologists and nurses in the ER are well organized and coordinated with the radiology and stroke units. I have also seen the management of other acute and paroxysmal neurological disorders. What really impressed me about this unit was the fluidity of information regarding the arrival of new patients and the resulting speed of care but also the higher age of patients with acute cerebrovascular events compared to my country. This is probably due to the youthfulness of our population and the negative lifestyle changes. I would like to thank Dr. Hannes, who despite the urgency of the place, found the time to explain each procedure to me.

I also had time to visit the city of Leipzig

This department visit program was a wonderful exchange of experiences and practices and an opportunity to create an academic network for future cooperation.

I will especially try to improve the practice of clinical neurophysiology in my department with all that I have learned. I will also try, with the support of the head of my department and all faculty members, to draw the attention of the political health authorities to the importance and necessity of setting up the conditions for acute stroke management.

Finally, I would like to thank Herwig-Landry who arranged my visit, and Mrs. Tetzlaff who helped me a lot with all administrative procedures during my stay.

Thanks to all the staff at Universitätsklinikum-Leipzig for their hospitality during my rotation at different units. •

Prisca-Rolande Bassolé is Associate Lecturer in Neurology at Fann Teaching Hospital in Dakar, Senegal.