St. Michael’s Hospital is home to a unique stroke clinic, where patients see three different specialists during the same appointment, saving patients time and ensuring their healthcare team works together to develop a complete care plan that meets their needs.  

The Stroke of Unknown Cause Clinic (SOCC) at St. Michael’s is a specialized program for patients who’ve had a stroke where the cause is not known. It addresses a problem Dr. Atif Zafar noticed in the way stroke care is delivered in Ontario: Patients wait a long time to see their specialists.

“The traditional complex stroke clinic care model often involves multiple tests and consultations with different specialists — a process that can span months,” said Zafar, a neurologist who became the medical director of the stroke program at St. Michael’s after a career in the U.S. “In this clinic, we compress that timeline into a single hour-long visit, fostering seamless physician collaboration and empowering patients with timely answers and comprehensive care.”

Patients of the SOCC see their stroke specialist, hematologist and cardiologist at the same time– an efficient care model that allows for more teamwork and brainstorming, said Zafar.

“Whether it’s identifying a small hole in the heart, addressing a rare blood disorder, or managing other conditions, our patient-centred approach ensures that healthcare revolves around the patient,” he said.  

“Not only does this provide our patients with a care environment where they feel supported and hopeful, it can lead to life-changing outcomes.”

Since launching in April 2022, the clinic, which operates once per month, has cared for more than two dozen stroke survivors.

‘Right people at the right time’

Chenthuran Ratnam is one of these patients.

Ratnam, 52, was taken to the St. Michael’s Emergency Department after a major motorcycle crash in the summer of 2022. It was during hip and knee surgery at St. Michael’s that physicians discovered that he had suffered a stroke.

Because the cause of Ratnam’s stroke was unclear, he was referred to the SOCC, where he was cared for by Zafar, cardiologist Dr. Sami Alnasser and hematologist Dr. Eric Tseng.

The SOCC team confirmed his stroke diagnosis, ruled out other stroke-like conditions through brain imaging, determined the best way to administer blood thinners, and also discovered that Ratnam had a hole in his heart. 

The team felt that Ratnam’s heart defect was an important factor in his unusual stroke, and he had the hole fixed via a minimally-invasive, same-day discharge procedure at St. Michael’s.

This model of care benefits stroke patients, who often have various questions that can’t be answered by just one specialist, said Alnasser.  

“Sometimes, when patients have a stroke the underlying reason and next steps are unclear. Patients often have questions that cannot answered by one specialist. As a result, patients often must see several different specialists over an extended period to sort out what is happening, but these assessments can be fragmented and communication is confusing or challenging,” Alnasser said.

“In this clinic, we have gathered specialists from stroke neurology, thrombosis (blood clotting disorders) and from cardiology to sit together to review and discuss the patient’s story, their prior tests and imaging, and then meet the patient afterward to explain what is happening and next steps. This is all done in a single meeting, in an integrated manner with the patient, to help expedite the investigations and treatments that are needed, with the ultimate goal of preventing stroke in the future.”   

Now Ratnam is on the road to recovery, with appointments for physiotherapy and rehabilitation, along with follow-up appointments with the SOCC team.

“The St. Michael’s team provided excellent care, with clear communication of what I had and what to expect. They explained everything to me in a good manner, so I didn’t get a panic attack,” Ratnam said. “I always say, ‘I was with the right medical people, at the right time.’”

By: Marlene Leung