Vascular Neurologist: Your Brain Vasculature & Stroke Specialist

Many people see a vascular neurologist for the first time when their primary care doctor or other specialist finds or suspects a cerebrovascular disease or condition, such as a vascular malformation or carotid stenosis. Cerebrovascular diseases and conditions affect the blood vessels of the brain or spinal cord. Your doctor may also refer you to a vascular neurologist for further evaluation of symptoms or risk factors for serious cerebrovascular conditions, such as stroke.

Seeing an experienced vascular neurologist for early treatment or preventive care before serious cerebrovascular problems occur is the best way to reduce the risk of permanent damage, disability, and other complications.

Consider seeking care from a vascular neurologist if you have any of the following symptoms or conditions: 

• Headaches, neck or back pain, weakness, numbness, or dizziness that your doctor believes needs specialized evaluation

• Problems with eyesight, memory, speech, decision-making, balance, coordination, or muscle control that your doctor believes to be caused by a problem in the blood vessel of the brain or spinal cord

You should also seek care from a vascular neurologist under the following situations:

• You need specialized tests or procedures of the blood vessels of the brain or spinal cord.

• You have serious cerebrovascular risk factors.

• Your primary doctor or specialist finds a vascular abnormality that needs further evaluation.

• You have a cerebrovascular condition or disease that requires ongoing monitoring and specialized care.

A vascular neurologist treats conditions and diseases including:

• Blood vessel malformations including venous and arteriovenous malformations

• Brain aneurysm, a ballooning of a brain artery wall that can rupture and cause bleeding in the brain (cerebral hemorrhage)

• Brain or spinal cord injury including severe head injury with bleeding into the brain (cerebral hemorrhage)

• Cerebral vasculitis, an inflammation of blood vessels of the brain

• Narrowing of arteries that supply the brain with blood, including carotid artery stenosis and vertebrobasilar stenosis

• Stroke including stroke caused by a blood clot (ischemic stroke), bleeding into the brain (hemorrhagic stroke), and childhood stroke

• Transient ischemic attack (TIA), a set of stroke-like symptoms that could be a warning sign of a full-blown stroke

A vascular neurologist can order, perform and interpret a wide variety of diagnostic and screening tests including:

• General health and screening tests including complete blood count (CBC), blood culture, spinal fluid analysis, urinalysis, blood glucose (sugar) test, electrolyte tests, liver and kidney function tests, blood pressure screening, blood oxygen level (pulse oximetry), and arterial blood gas testing

• Electroencephalogram (EEG) to record the brain's electrical activity and help diagnose such symptoms as seizures, fainting, or blacking out

• Imaging tests including X-rays, computed tomography (CT) scans, nuclear scans, ultrasound of the carotid and vertebral arteries, transcranial ultrasound Doppler, and magnetic resonance imaging (MRI)

Vascular neurologists order or perform various procedures and treatments, but they do not perform surgery. Vascular surgeons or neurosurgeons usually perform blood vessel, brain, or nervous system surgery. Procedures that vascular neurologists may perform, order and interpret include: 

• Cerebral angiography, a type of X-ray in which a special dye is injected through a catheter to show how blood flows through brain arteries

• IV-tPA, an intravenous medication to dissolve a blood clot that is causing a stroke

• Lumbar puncture, also called a spinal tap

• Management of stroke recovery including rehabilitation

• Medications for stroke prevention including anticoagulants and antiplatelets, which inhibit blood clotting

• Prevention and management of neurological complications, including cerebral edema and increased intracranial pressure, infection, and arrhythmias

• Risk screening for stroke, TIA, and other cerebrovascular conditions, and management of risk factors, such as hypertension and high cholesterol

Education, training, experience and certification are key elements in establishing a doctor’s level of competence. Board certification in vascular neurology verifies that a doctor has completed residency training in the specialty and has passed competency examinations.

A board-certified vascular neurologist has:

• Graduated from medical school or a college of osteopathic medicine, earning an MD or DO degree

• Completed specialized residency training and earned certification in neurology by the American Board of Psychiatry and Neurology

• Completed an accredited fellowship training program in vascular neurology

• Passed a certification exam that validates the doctor’s specialized knowledge and skills in vascular neurology

To maintain board certification in vascular neurology, a doctor must complete the American Board of Psychiatry and Neurology’s Maintenance of Certification program in neurology.

Vascular neurology is a subspecialty of neurology. The American Board of Psychiatry and Neurology does not formally recognize any subspecialties of vascular neurology. However, there are vascular neurologists who are leaders in their field or in treating a specific type of vascular condition, such as brain aneurysm or stroke.

Other board-certified specialists, such as neurologists and neurosurgeons, also treat people with problems of the blood vessels of the brain and spinal cord. Talk to your doctor about the best kind of specialist or subspecialist for you and ask for referrals to well-respected doctors. When considering a vascular neurologist, ask for details about his or her training and experience.