I would like to express my sincere gratitude to the European Stroke Organisation (ESO) for granting me the opportunity to participate in the Department to Department Visit Programme. This experience offered an exceptional chance to expand my clinical and research competencies in stroke medicine, gain insights into a leading European stroke centre, and establish valuable professional connections.

My decision to choose UKE Hamburg as my host institution was straightforward. UKE has an outstanding reputation in stroke care, research, and innovation, and has played a significant role in several landmark clinical trials, including the WAKE-UP study, which investigated MRI-guided thrombolysis in wake-up strokes. The organisation of the visit was smooth and efficient, and I am deeply grateful to Prof. Dr. Götz Thomalla, who was exceptionally supportive and welcoming, as well as to Tamara Wichmann (Assistant to the Clinic Director) for her kind and helpful coordination.

Stroke Unit

During my stay, I was integrated into the daily workflow of UKE’s modern and well-organised Stroke Unit, which includes 10 single-bed rooms, two three-bed rooms, and two two-bed rooms.

My activities included:

• Participation in the evaluation of patients presenting with ischemic stroke, TIA, and hemorrhagic stroke,
• Differential diagnosis of acute neurological deficits, including stroke mimics,
• Attendance and participation in morning rounds with senior neurologists and residents,
• Observation of workflow, multidisciplinary communication, and logistics of the unit, from admission to discharge,
• Exposure to the use of echocardiography (TTE/TEE) and long-term ECG monitoring in stroke diagnostics,
• Daily admission and case discussion meetings,
• Insight into patient flow, decision-making pathways, and rapid diagnostic processes within a highly coordinated stroke centre.

Other Departments
Functional Diagnostics Laboratory

I visited the Functional Diagnostics Laboratory, where I had the opportunity to deepen my understanding of EEG usage in both outpatient settings and critical care.

Emergency Department

I spent several sessions in the Emergency Department, observing the acute triage and management of neurological patients. My activities included:

• Assessment of differential diagnoses, such as metabolic disturbances, seizures, migraines, and functional disorders,
• Observation of the acute stroke workflow, from prehospital notification to imaging and treatment decisions,
• Participation in the evaluation of both neurological and non-neurological emergencies.

Neuroradiology Department

In the Neuroradiology Department, I observed several interventional procedures, including:

• Coiling of intracranial aneurysms,
• Stenting of carotid artery,
• Imaging evaluation and treatment planning for complex neurovascular pathologies.

These experiences highlighted the importance of close collaboration between neurologists and interventional neuroradiologists.

Neurovascular Board

I attended the Neurovascular Board meetings, where neurologists and interventional neuroradiologists reviewed and discussed complex cases, arteriovenous malformations, carotid stenosis, and other challenging diagnostic and therapeutic cases. These multidisciplinary discussions offered valuable insights into structured decision-making and evidence-based treatment planning.

Personal Experience and Impressions

Hamburg is a vibrant and beautiful city, and I found it a very enjoyable place to stay. The atmosphere at UKE was extremely welcoming. My mentor, Priv.-Doz. Dr. Bastian Cheng, as well as all team members, were friendly, open, and always willing to explain clinical reasoning or procedures in detail. I felt fully integrated into the team and appreciated the collegial environment throughout my stay. A huge thank you to them!

Conclusions

My visit to UKE Hamburg was enriching both professionally and personally. I gained valuable clinical experience in stroke diagnostics and acute management, advanced my understanding of neurovascular interventions, and deepened my knowledge of essential diagnostic modalities.

Witnessing the organisation and efficiency of stroke care in a high-volume, research-active centre was particularly inspiring. I am deeply grateful to the European Stroke Organisation for supporting this programme and to UKE Hamburg for hosting me so warmly. This experience will significantly contribute to my future clinical work, academic development, and dedication to the field of stroke medicine.

The experience I had in Oxford and the knowledge I acquired over the past six months were highly meaningful and allowed me to grow both professionally and personally. This was made possible in part thanks to the funding provided by the European Stroke Organisation through its Department to Department Visit Programme. I am therefore very grateful for this support, as this research placement has enabled me to enrich my current project, which involves the application of a novel therapy using functional electrical stimulation coupled to a P300-based brain–computer interface for upper limb motor rehabilitation in chronic stroke survivors.

Spending six months studying and conducting research in Oxford was the most unique and special experience. At first, it was difficult to realise not only the fact that I was at one of the oldest universities in the world—where some of the brightest minds in history once shared the same libraries, laboratories, and lecture halls in which I was now standing—but also that the historic and quaint nature of its buildings, streets, and colleges creates the illusion that time has stood still, making you feel in a fairy tale or Harry Potter story.

Additionally, I was able to get the most out of my time in Oxford under the mentorship of Prof. Charlotte Stagg and Prof. Melanie Fleming, who served as my host co-supervisors within the Physiological Neuroimaging and Plasticity groups at the Oxford Centre for Integrative Neuroimaging. From the moment I arrived, I felt very welcome in their laboratories, and I was particularly impressed by the pleasant and friendly working environment I found there, where everyone was willing to help, fostering a dynamic of collaboration and cooperation that I greatly enjoyed.

Moreover, I would like to highlight the amazing academic and scientific activities in which I participated during my research stay. I learned how to analyse neuroimaging studies obtained from subjects in the project we are conducting in Mexico, including magnetic resonance imaging and electroencephalography studies. In addition, I also had the opportunity to get involved and assist in a clinical trial at the John Radcliffe Hospital, where we applied beta transcranial electrical stimulation to improve upper extremity motor recovery in stroke individuals. Furthermore, through various workshops, I learned how to apply other non-invasive brain stimulation and neuromodulation techniques, and I attended conferences, seminars and symposia that allowed me to appreciate different approaches and methodologies to conduct research.

Finally, I was not only able to learn and benefit from my time in Oxford, but I was also able to contribute my own skills. This included doing physical examination assessments for the clinical trial in which I participated in, as well as training other students on how to perform and evaluate different clinical scales used to assess motor function and recovery in stroke patients, given I was previously trained at a tertiary rehabilitation center in Mexico, the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra. The above demonstrates that bidirectional collaboration is possible and that both parties can learn and enrich each other.

Overview of Training and Activities

1. Acute Stroke Management: I studied the algorithms of emergency management for acute ischemic stroke, including the administration of thrombolytic agents (tenecteplase) and mechanical thrombectomy. A key point of interest was the clinical approach to using tenecteplase (TNK) as an alternative to alteplase, with individualised dose selection. I also familiarised myself with the rapid diagnostic workflow involving CT, MRI, and perfusion imaging, aimed at minimising door-to-needle time and optimising patient outcomes.
2. Work in the Stroke Unit: I observed patient care in the Stroke Unit under continuous neurological and cardiovascular monitoring. I participated in discussions on early rehabilitation planning with the multidisciplinary team (neurologists, physiotherapists, speech therapists, occupational therapists, and neuropsychologists). I learned about standardised clinical protocols focused on early recovery of motor and cognitive functions following stroke.
3. Diagnostics and Prevention: I became acquainted with modern diagnostic approaches for identifying the etiology of stroke — including cardiogenic, vascular, hematologic, and rare genetic causes. I studied contemporary approaches to lipid-lowering therapy, including the use of high-dose statins and dual-component therapy to achieve aggressive cholesterol reduction. I participated in consultations on secondary prevention, including the management of patients with TIA and cryptogenic stroke.

Academic and Educational Component

During the visit, I attended clinical case discussions and educational sessions dedicated to: The comparison of Inselspital’s stroke management protocols with national practices. The exchange of experience in diagnostic and therapeutic strategies in acute stroke; Observation of the role of teamwork and process standardisation in achieving high-quality patient outcomes.

Conclusions and Implementation of Knowledge

1. The knowledge and skills acquired during the visit will contribute to improving the quality of acute stroke care, particularly in optimising the time intervals before thrombolytic therapy initiation.
2. I plan to evaluate the feasibility of implementing tenecteplase-based protocols for ischemic stroke within the framework of national guidelines.
3. My competence in selecting and managing intensive lipid-lowering therapy has been enhanced, which will improve strategies for preventing recurrent vascular events.
4. The experience gained in multidisciplinary teamwork and rehabilitation planning will be applied to increase the efficiency of post-stroke recovery in my home institution.

The observership at Inselspital Bern, under the supervision of Dr. Seiffge, Dr. Bücke, and Dr. Birner, provided me with invaluable exposure to advanced European standards in stroke management and vascular neurology. The acquired knowledge will be implemented in my daily practice to improve the quality and effectiveness of stroke care in my department.

Acknowledgement

I would like to express my sincere gratitude to the European Stroke Organisation (ESO) for awarding the grant that made the D2D Visiting Programme possible. The support of the ESO has significantly contributed to my professional development and to international collaboration in vascular neurology.

Firstly, I sincerely thank the European Stroke Organisation and Prof. Dr. Daniel Bos for providing me with the opportunity to visit Erasmus MC, Rotterdam in June 2025 through the D2D Visit Programme. The visit offered an ideal combination of professional development, clinical teaching, interdisciplinary collaboration, new project ideas, and memorable experiences.

My passion for stroke care has grown significantly in recent years, leading me to combine my neurology residency with a doctoral research project focused on stroke. A key component of my PhD is an imaging sub-study of a randomised clinical trial, aiming to improve diagnostic and therapeutic strategies for stroke patients with atherosclerosis. I have collected and analysed more than 500 CTA and NCCT scans, assessing plaque characteristics to improve risk stratification in patients with vulnerable plaques.

Prof. Dr. Daniel Bos is a recognised expert in the field of extra- and intracranial atherosclerosis. The ESO Department-to-Department Visit Programme provided me with the opportunity to further analyse these scans using advanced software that enables detailed assessment of plaque volume and composition. In addition, we were able to initiate a new project focusing on intracranial atherosclerosis, thereby expanding our research collaboration.

From the very beginning, I was warmly welcomed by Prof. Bos and his team, whose support and enthusiasm made the experience both productive and enjoyable. During my two-week stay in Rotterdam, I had the opportunity to work closely with the Radiology Department on our ongoing collaborative research projects. I also visited the Neurology Department and participated in teaching activities with medical students and residents. Beyond the professional aspects, I also took the time to explore Rotterdam during a few “running breaks” and visited Hoek van Holland in beautiful weather.

In summary, it was a true privilege to visit Erasmus MC and the city of Rotterdam. I was delighted to learn that ESOC 2026 will be held in Maastricht, right on the border between the Netherlands and Belgium — a great opportunity to reconnect with the Erasmus MC team. I would once again like to express my sincere gratitude to the ESO for offering me the opportunity to participate in the D2D Visit Programme.

This report follows my one-week observership at the Istituto Neurologico Carlo Besta in Milan, Italy, under the mentorship of Dr. Anna Bersano. Earlier this year, in March, I had the privilege of attending the ESO Focused Workshop on Cerebral Amyloid Angiopathy (CAA), organised by Dr. Bersano’s team. Returning in September for this observership provided a natural and enriching continuity: the insights gained during the workshop became the foundation for the clinical experiences and impressions I developed during my stay.

From the very first day, the institute’s rich heritage and reputation were immediately evident. Founded in 1918 and officially recognised by the Italian government as an Institute of Research and Treatment since 1981, Carlo Besta Institute seamlessly blends tradition with cutting-edge clinical and research excellence. I was intrigued to learn that Newsweek ranks the institute among the world’s leading specialised neurology hospitals—a recognition that is clearly reflected in both the care provided and the quality of ongoing research.

My observership was profoundly enriched by the mentorship of Dr. Anna Bersano, whose expertise as Director of the Cerebrovascular Unit made the experience both educational and inspiring. Her generous guidance enabled me to engage fully with both the clinical and scientific dimensions of advanced cerebrovascular medicine.

The primary focus of my stay was on rare cerebrovascular diseases, including Moyamoya disease, CADASIL, and cerebral amyloid angiopathy. I was particularly struck by the meticulous care with which each patient’s journey was approached: reconstructing clinical histories, and integrating neuroimaging and biomarker insights into a cohesive diagnostic and therapeutic strategy. A defining strength of the institute is its truly multidisciplinary approach, especially in managing highly complex neurosurgical and endovascular cases. I had the opportunity to observe detailed planning and execution of treatments for arteriovenous malformations, dural fistulas, and complex aneurysms. One of the most impressive aspects was witnessing surgical treatment for Moyamoya disease, where cerebral bypass procedures offered patients renewed hope and quality of life. The seamless collaboration between neurologists, neurosurgeons, and interventional neuroradiologists was exemplary, representing an outstanding level of integration.

Equally impressive was the work of the Laboratory of Cellular Neurobiology, led by Dr. Laura Gatti. Her team conducts highly specialised investigations and in-depth biomarker analyses essential for diagnosing of cerebral small vessel diseases. Observing the precise and effective translation of laboratory science into clinical decision-making was profoundly enlightening, reaffirming the institute’s stature as a center of excellence. My daily rhythm at Carlo Besta Institute was intensive and deeply inspiring. Mornings were spent on the ward, discussing and examining patients, while afternoons were devoted to outpatient follow-ups with patients affected by rare cerebrovascular disorders. In parallel, I was able to engage with ongoing research activities, further enriching my experience.

Throughout my visit, I felt genuinely welcomed by the entire team. I am especially grateful to Dr. Benedetta Storti, Dr. Nikola Rifino, Dr. Isabella Canavero, Dr. Irene Scala and psychologists Giulia Marinoni and Carolina De Toma, who created an open, collegial, and intellectually stimulating environment. Their willingness to share knowledge and involve me in clinical reasoning processes made me feel part of the team, despite the brief nature of my stay.

I returned home with not only new knowledge but also a strong sense of connection—to the people, to the institute, and to a global community dedicated to advancing the understanding and treatment of rare cerebrovascular disorders.

With deep gratitude, I wish to thank Dr. Anna Bersano for her exceptional mentorship and leadership, as well as my colleagues for their generosity, kindness, and dedication. My week in Milan was more than a professional milestone—it was a personal inspiration. It was a true privilege to witness the highest standards of care and research in the field of rare vascular diseases.

Learn more about the Emerging Leader Programme here:

https://eso-stroke.org/resources/emerging-leader-programme/

and explore the D2D Programme here:

https://eso-stroke.org/resources/department-to-department-visit-programme/

I had the opportunity to participate in the ESO Department-to-Department Visit Programme at the Stroke Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, from August 18 to August 29, 2025.

During the two weeks, I was introduced to the organization of acute stroke care in Denmark, including stroke unit rounds, acute stroke calls, multidisciplinary meetings with nurses, physiotherapists, occupational therapists, and speech therapists, as well as patient follow-up and rehabilitation planning. The programme allowed me to observe the high level of team-based coordination, transparent communication with patients and families, and the use of national registries to ensure quality of care. In addition, I had the chance to give a presentation about neurology and stroke care in Ukraine to colleagues at Rigshospitalet, which was a very meaningful opportunity to share experiences and raise awareness about the challenges of providing care in a war-affected healthcare system.

This visit gave me valuable insights into best practices in acute stroke management, interdisciplinary collaboration, and patient-centered communication, which I intend to apply in my clinical work and teaching activities in Ukraine. I am grateful to Professor Hanne Christensen and her colleagues for the excellent organization, hospitality, and support throughout my stay.

Learn more about the TF4UKR D2D Programme: https://eso-stroke.org/resources/tf4ukr/

As part of the Department-to-Department (D2D) ESO Programme, I completed a visit to the Department of Stroke Medicine, Leicester Royal Infirmary, United Kingdom, under the mentorship of Professor Dr. Jatinder Minhas. This experience has been an invaluable part of my professional and personal growth, and I am truly grateful for the support that made it possible. During my stay, I was able to observe several aspects of stroke care across different clinical settings. I gained direct exposure to acute stroke services, particularly in the Emergency Department and Acute Stroke Unit with Dr. Minhas and team, where I learned how patients are rapidly assessed by consultants and registrars, transferred for imaging within minutes, and thrombolysed when indicated. This efficiency of care and structured pathway was an important learning point for me. I also attended the virtual Heart-Brain multidisciplinary team (MDT) meeting, where I witnessed how complex cases are reviewed holistically, and decisions are made collaboratively, keeping both neurological and cardiovascular aspects in view. In addition to acute stroke, I spent time in the TIA and outpatient clinics with Dr. Musarrat, where I observed follow-up patients and learned how recurrent or mimicking conditions are approached in the UK system. I also joined ward rounds in the acute stroke ward with Dr. Moqsith, where I deepened my understanding of inpatient management and protocols. I was particularly impressed by the seamless use of electronic medical records — integrating prior history, scans, referrals, and prescriptions into one platform — and how this supported safe and efficient care delivery by both doctors and nurses. This experience was vastly different from what the practices are at our center and Nepal as a whole. Another important component of my visit was shadowing with the consultant during stroke rehabilitation services at a community hospital. There, I saw how patients discharged from tertiary care hospitals continue their recovery, with emphasis on physical, emotional, occupational, and social reintegration. The model of utilising highly trained nurses with consultant input during rounds was especially enlightening, and it broadened my understanding of how stroke care is extended beyond acute treatment into long-term rehabilitation. Beyond the hospital, I had the opportunity to experience Leicester’s diverse cultural and social environment. Professor Minhas was an outstanding mentor who not only guided me clinically but also helped me integrate into the local setting, introducing me to members of the community and encouraging me to explore the city and beyond. His mentorship, hospitality, and encouragement were central to making this visit as rewarding as it was, and I remain deeply grateful to him. Following my observership in Leicester, I also had the privilege of attending the ESO Stroke Research Workshop in Edinburgh (September 2025). The workshop was immensely insightful and helped me refine and shape my own research ideas. The sessions on study design, methodology, and collaborative opportunities provided me with practical tools that I plan to integrate into my future work. Overall, this ESO-supported visit has been a truly transformative experience. As a primary care physician in Nepal with aspirations to specialise in neurology, I will carry these lessons forward and hope to work with local stakeholders to strengthen stroke pathways and rehabilitation services in my own setting. I am also keen to continue collaborations in the future, both with ESO and with colleagues I met in Leicester. Thank you once again to ESO for making this possible. With warm regards, Dr. Abhishek Chapagain Medical Officer, Chisapani Hospital, Nawalparasi, Nepa Learn more about the D2D Programme: https://eso-stroke.org/tag/d2d/