Medical Staff Pulse is
a Publication of the Chief of Staff
2 Minutes with ... David Palestrant M.D.

Dr. Palestrant serves as Cedars-Sinai's director of Neuro-Critical Care and the Stroke Program, the latter of which The Joint Commission recently certified as a Primary Stroke Center.

When not seeing patients, Dr. Palestrant loves spending time with his young daughter Nola and daydreaming about future trips around the globe.

What drew you to neurology?

I studied both internal medicine and neurology. I was fascinated by the intellectual side of neurology, but at the same time liked the high acuity of internal medicine. I tried to combine my interests by going into neuro-critical care and stroke neurology.

Congratulations on the Stroke Program's recent certification. How did you develop an interest in studying and treating stroke?

A few reasons, once again it was my preference for higher acuity and emergent medicine. Also, during residency, I treated patients with neurologic injury who were very ill and was surprised by how well some of them did if they got rapid and aggressive up-front care. I also felt stroke and neuron-critical care could be the areas I could have the most impact with my background. Lastly, it's interesting being in these two emerging areas of medicine, which are so rapidly evolving.

Cedars-Sinai is developing a dedicated team to treat mini-strokes called transient ischemic attacks. Why is this so important? How do you increase awareness among people regarding this condition?

Transient ischemic attacks are very worrisome events. It's very important people have a rapid workup because 20 percent of people who have a TIA experience a stroke within two weeks.

There are ongoing campaigns by the American Heart Association and the National Stroke Association. We also have an outreach program at Cedars-Sinai that does educational events at churches and synagogues where we teach people about the symptoms. However, I think it's not enough and there needs to be more awareness created.

What are your goals for the two programs you direct?

The Neuro-Critical Care program is moving into its second stage of development with Dr. Chad Miller, a second neurointensivist who joined the team one month ago. Over time, we need to increase the specialization of the unit. This includes both increased nursing specialization and implementations of new technologies that allow for multi-modality monitoring of the brain-injured patients to give us more real time information of what's occurring in the brain at any given time, such as continuous EEG monitoring and cerebral micro dialysis. We are striving to make the Neuro ICU program here one of the best in the country. Setting up fellowships and additional research are part of the plan, too.

We want our Stroke Program to become a bigger tertiary referral system. Our program goals include creating a system that will immediately treat TIA, continue to improve our rapid system for stroke evaluation, develop mechanisms for rapid transfers into Cedars-Sinai, and continue to improve our continuum of care once patients have been treated. Also, we want to increase the research and academic portions of the program.

What is the most meaningful or inspiring thing a patient has said to you?

In a general way, many of the patients are very inspiring. Their lives and those of their families are forever changed after we come in contact with them. The hardest part of my job, however, is talking to families. We see both the functional and dysfunctional, but it's always inspiring to see families who have the forethought to plan for such events.

I had one patient who was dying from cancer, but had made peace with his condition. He had this clarity of where he was and what time he had remaining. I found that grace very inspiring.

Where did you grow up?

I grew up in South Africa and came to the U.S. almost 21 years ago. I left South Africa a few months after I finished high school, when the country was in the midst of apartheid, a truly awful period. Conscription for white males was mandated, which is one of the reasons that my family left. We didn't want to fight for the government of that time.

I've been to South Africa several times since and have traveled throughout Africa, teaching in Uganda. I am very interested in medicine in Third World countries.

Do you have any dreams of taking some of the work you've done at Cedars-Sinai to such places?

I've only been here for about a year and I've got a 2-year-old daughter at home, so I haven't had much time to think about that yet.

I really do enjoy international work and I'm trying to find ways of doing that and taking what we have here to other countries.

Is there some location you have yet to see that's on your list of places to visit?

I'd love to do a long trip through South America, especially Argentina and Chile. If I had my druthers, I'd also pack up a tent and slowly work my way through all the national parks in the West and up into Canada. I'd like to do the same with Australia. I grew up with a very outdoor life, so any opportunity I have to get outdoors and into nature, I try to grab.

I'd also like to see Antarctica.