Johns Hopkins stroke specialists are skilled in advanced medical, surgical and minimally invasive treatments, giving many stroke patients hope for recovery. Our patients also benefit from access to Johns Hopkins clinical trials and research and skilled nursing care. The Neurosciences Critical Care Unit (NCCU) ensures expert care, informed by the latest research and tailored to the specific needs of individuals with stroke and other neurologic and neurosurgical conditions.
Learn more about our approach to comprehensive stroke care:
Emergency Services | Acute Services | Long-term Management and Prevention | Telemedicine | Clinical Trials
Our Approach to Stroke
The Stroke Center team is on a mission to improve the life of every patient who has had a stroke. Hear from our experts about the multifaceted treatment strategies we use to help those at all stages of stroke recovery.
Emergency Stroke Services
Our multi-specialty team offers patients comprehensive treatment plans from the moment they arrive at the hospital, with world-class emergency medicine physicians, vascular neurosurgeons, interventional neuroradiologists, neuroradiologists, neurointensivists, rehabilitation specialists and stroke care experts working together on your evaluation and treatment.
-
Medications that dissolve clots, called thrombolytics or fibrinolytics, are commonly known as "clot busters” and can help reduce the damage to brain cells caused by the stroke. Dissolving the clot may restore blood flow to the brain and decrease the severity of symptoms. To be most effective and safe, these agents must be given within 4.5 hours of a stroke's onset. At the Johns Hopkins Comprehensive Stroke Center, currently 75-100% of patients receive the clot buster medication within an hour of arrival at the hospital.
-
Clot buster medications can be given directly at the clot using intra-arterial (IA) techniques if patients meet specific criteria using MRI imaging. This therapy can be used after the time window for intravenous therapy has passed. Clot retrieval devices along with IA therapy can remove clots from the brain and restore blood flow.
-
The Brain Attack Team responds to patients suspected of having a stroke and includes a coordinated team. When a patient presents to the emergency room with stroke symptoms with a time of onset within 24 hours, a BAT call is activated, and a member of the Brain Attack Team will arrive to evaluate the patient within 15 minutes of arrival. EMS can activate a BAT call before the patient arrives. A member of the BAT team will follow the patient through evaluation, diagnostic testing, and emergency treatment and through transfer to a Neurology floor, evaluating any neurologic changes.
-
MRI is often the first diagnostic test for stroke patients, allowing physicians to evaluate the presence, location, and severity of a stroke and to make decisions about emergency treatment. MRI, CT, CTA, CTP is available 24/7 to patients in the Emergency Department. Intra-arterial tPA is another test that may be recommended.
-
Stroke patients are at risk for having difficulties swallowing (dysphagia), and all patients suspected of having a stroke are restricted from having oral intake until a swallow screen can be performed to reduce the risk for aspiration (choking).
-
Patients with stroke symptoms are evaluated with the National Institution of Health Stroke Scale (NIHSS) in the emergency department to determine the severity of their stroke. This test is the standard evaluation for all stroke patients and is a quick way of communicating information about a patient’s condition to other providers. It is also used to evaluate changes in neurologic status throughout admission to the hospital.
-
Depending on the type of stroke and the cause, procedures may include thrombectomy, endovascular coiling for brain aneurysms, hemicraniectomy, and surgery to repair aneurysms and arteriovenous malformations (AVMs).
-
ICP can increase after stroke, and the brain is at risk for further damage through herniation. There are several interventions that can be used to manage increased ICP including special types of intravenous (IV) fluids like hypertonic saline, or changes in breathing through intubation and hyperventilation. ICP can be monitored and managed with an intraventricular catheter, which is inserted directly into the brain.
Acute Stroke Services
-
Patients are transferred to intensive care or acute care depending on their condition. All patients have 24/7 coverage by a neurologist.
-
The BRU has 12 beds dedicated to stroke patients. The unit is staffed with specially trained neurology nurses who are skilled in identifying critical changes in the patient’s condition.
Safety screenings are performed on all patients for stroke-related conditions. They include swallow screens for dysphagia, orthostatic blood pressures, cardiac monitors for atrial fibrillation and other arrhythmias.
Patients receive PT/OT/SLP daily and upon discharge patients receive follow up care in the JSTTEP and Stroke Prevention Clinic.
A team of physicians see stroke patients daily. Dedicated stroke units, such as the Brain Rescue Unit, provide better patient outcomes.
-
Occupational and physical therapists make recommendations for patient placement for therapy depending on their condition and ability to participate in therapy. Patients can be referred to inpatient or outpatient physical and occupational therapy and neuro-rehab. Speech-language pathologists also evaluate and work with patients on their speech and swallowing difficulties.
-
- Carotid endarterectomy (for carotid stenosis)
- Endovascular Angioplasty with Stenting (CAS)
- Transcarotid Artery Revascularization (TCAR)
Stroke Clinical Trials
A clinical trial is a method for medical researchers to study, test and discover effective treatments. Clinical trial research studies can occur in a lab or involve human beings.
Find stroke clinical trials at Johns Hopkins on ClinicalTrials.gov.