Neurosurgeon Andrew Carlson, MD, is no stranger to complex conditions. Fellowship trained in endovascular neurosurgery and skull-base/open cerebrovascular neurosurgery, he has more than a decade of experience providing some of the most specialized care for brain-related problems. This includes brain aneurysms, brain tumors, large strokes, and more.
"I am amazed by how rapidly developing the field is and how much we are discovering every day regarding how the brain works and what we can do to help it work better," Carlson says.
In this Q&A, he shares how providers can help their patients avoid and navigate the complicated neurological conditions he treats.
What's something you wish every provider knew about your specialty area?
The thing that has completely changed the paradigm in vascular neurosurgery is that strokes of all kinds are increasingly treatable when we can get to patients early. New symptoms such as balance difficulty, vision problems, facial droop, body weakness, or speech difficulty require emergent evaluation to determine if there is a problem that we can help with.
What are the most important risk factors for providers to look out for in their patients?
Patients who smoke, have high blood pressure, and who have family members with brain aneurysms are at risk of a brain aneurysm themselves. These types of patients should undergo a screening MR-angiogram to determine if there are aneurysms.
Even for small, low risk aneurysms, I discuss and reassure patients in detail when there is no need to worry and when we should consider treatment. Just getting a finding of a brain aneurysm or other similar problem does not necessarily mean that it needs invasive treatment.
How can providers help their patients with early detection and diagnosis?
Patients know their bodies better than most physicians. Many times, a new symptom can lead to an important early diagnosis and may require follow-up to obtain specialized imaging when there is a possible finding on a screening image.
For stroke, prevention is always better than treatment. This includes things like blood pressure management, smoking cessation, increased activity, better diet, and managing risks like atrial fibrillation.
What's one thing providers can start doing today to help their patients?
Encourage the benefits of increasing plant-based parts of patients’ diets!
What’s your favorite thing about practicing as a specialist?
Most patients I have seen have seen several doctors and are can be confused and nervous — not knowing what to expect. Being able to discuss these problems with my extensive focused clinical experience and, in many cases, research that relates directly to a patient’s problem, helps me put the patient at ease that we understand the next steps. This ability to reassure and guide patients and families through these sometimes difficult journeys is the most rewarding part of my practice.
When should providers consider referring their patient to you?
I see patients with all kinds of complex cranial problems, mostly related to blood vessel problems. This includes aneurysms, arteriovenous malformations, dural fistulas, stroke, vessel stenosis, idiopathic intracranial hypertension, complex vascular tumors, and other similar problems.
How do you handle meeting a newly referred patient?
When I meet a patient, I make sure we both understand what we are there to accomplish and then get to better understanding how they arrived at this point and what is bothering them. I spend time going over images in detail and encourage patients to take pictures to better understand the problem we are discussing. I am also known to make frequent drawings to help explain the problem.
I like to ensure that I am working together with the referring physician to provide feedback and be available to answer any questions or concerns that may arise during treatment.