Liz Breese Marsh, MD
Vascular Neurology
- Johns Hopkins School of Medicine Faculty
About Liz Breese Marsh
Professional Titles
- Associate Director, Neurology Residency Program
- Director, The Comprehensive Stroke Center at Johns Hopkins Bayview
Primary Academic Title
Associate Professor of Neurology
Background
Dr. Elisabeth Marsh's clinical interest is in cerebrovascular neurology, and her clinical research focuses on stroke outcomes and recovery. Her clinical responsibilities include attending on the inpatient Stroke Service at the Johns Hopkins Hospital and inpatient Neurology Service at the Johns Hopkins Bayview Medical Center.
In 2014, Dr. Marsh was named the Medical Director of the Comprehensive Stroke Program at the Johns Hopkins Bayview Medical Center. She implemented the Bayview Stroke Intervention Clinic (BaSIC), a multi-disciplinary follow-up clinic designed to promote patient follow-up, reduce hospital readmission rates, and enhance post-stroke recovery. Her current focus is on the under-reported neurologic deficits (particularly with respect to depression, fatigue, and cognition) that significantly impair long-term functional outcome and patient satisfaction, despite scores on metrics such as the NIH stroke scale that indicate a “good recovery”. She leads a team of vascular neurologists, emergency medicine physicians, neurosurgeons, interventional neuroradiologists, neurointensivists, and rehabilitation specialists, who work together to provide the highest level of care to all stroke patients, resulting in better functional outcomes and improved quality of life.
She is also interested in the treatment of acute stroke and intracranial hemorrhage. Her past work has included evaluation of the predictors of hemorrhagic transformation following ischemic stroke. Using multivariable regression, she created a model that predicts rate of hemorrhagic transformation in patients with acute stroke on anticoagulation, the Hemorrhage Risk Stratification (HeRS) score. The tool is available for free through Apple by searching 'Johns Hopkins HeRS score' in the App Store.
Centers and Institutes
Clinical Trial Keywords
Reversible Cerebral Vasoconstriction Syndrome (RCVS)
Clinical Trials Summary
Reversible Cerebrovasoconstriction Syndrome: A Clinical Trial
Reversible cerebral vasoconstriction syndrome (RCVS) is a reversible vasculopathy, or narrowing of the blood vessels, that is an important cause of stroke in young people and most often affects women. RCVS classically presents with a thunderclap headache that can progress to cause intracranial hemorrhage (ICH) or ischemic stroke. The clinical and imaging characteristics of RCVS have been well characterized; however, the optimal therapy and best method to monitor treatment effect remains unclear. Patients presenting to Johns Hopkins Hospital and Bayview Medical Center with signs and symptoms consistent with RCVS are currently being enrolled in a clinical trial comparing two standard treatments: short acting nimodipine given every 4 hours, and longer acting verapamil given every 12 hours. They undergo monitoring of the blood vessels using transcranial doppler ultrasound (TCD) and monitoring with neurological evaluations and pain scales. After discharge they return to the clinic at 90 days for a repeat evaluation including neuroimaging and assessment. We will evaluate which medication is most effective at reducing symptoms and preventing complications such as stroke or ICH and hope that results will lead to a standardized treatment for RCVS that optimizes good outcomes.
Recent News Articles and Media Coverage
Keeping Previous Stroke Patients from Becoming Inpatients, NeuroNow (Spring 2015)
Research Interests
Intracranial hemorrhage, Outcomes, Recovery, Stroke
Research Summary
The Bayview Stroke Intervention Clinic (BaSIC)
Dr. Marsh is the Medical Director of Bayview Medical Center’s Stroke Program and, along with Dr. Rafael Llinas, runs The Bayview Stroke Intervention Clinic (BaSIC). BaSIC is a multidisciplinary outpatient clinic. Patients are seen within 4-6 weeks of their discharge from the Bayview Neurology Service so that key follow-up issues including post-stroke depression and fatigue can be addressed; persistent symptoms managed; and medications reconciled. Patients and families have the opportunity to see their stroke on neuroimaging, with the goal of truly understanding why the stroke occurred and the best way to decrease the chance of a future event. Our multidisciplinary approach allows for those with continued needs to be directly linked to our rehabilitation services. The program has already led to higher post-discharge follow-up rates, better adherence to risk factor modification strategies, and decreased rates of re-hospitalization.
In addition to patient care, BaSIC also serves as a clinical research environment focused on stroke outcomes. Together, we are identifying critical gaps in the knowledge of stroke recovery. Our long-term goal is to enhance post-stroke care by improving both symptomatic recovery and patient-centered outcomes. We are currently investigating factors related to cognitive decline post-stroke, and the influence of post-stroke depression, fatigue, and persistent symptoms on long-term recovery and quality of life for both patients and their families.
Magnetoencephalography- As part of our research, we are interested in higher level cognitive processes, such as attention and multi-tasking. After even small strokes these activities can become impaired. It may be because the brain functions as a network and you require all of your brain to be functioning normally to be at your best. In order to determine if this is the case and how connections change after stroke, we are partnering with New York University. Eligible patients with small strokes and difficulty with cognition on testing in our clinic travel to NYU where they undergo magnetoencephalography (MEG). Similar to an MRI, the MEG records which areas of the brain are active during various activities. Testing is performed about 1 month after stroke and repeated at 6 months. If we can determine the brain changes responsible for post-stroke cognitive impairment, we may be able to devise better treatment strategies to promote recovery.
Predicting Intracranial Hemorrhage: The HeRS score
Intracranial hemorrhage (ICH) is a devastating neurologic event. One form of ICH is hemorrhagic transformation of ischemic stroke (HT), which typically occurs in the days immediately following the infarct. HT often results in neurologic deficits, long-term disability, or death. It is unknown whether all types of ICH share common risk factors. The ability to predict who is at highest risk for HT and ICH is important to clinicians, particularly when considering treatment with anticoagulation, a common occurrence given the increasing frequency of patients with atrial fibrillation, blood clots, and mechanical valves. Anticoagulation itself likely increases risk of HT, making this group a potentially high-risk patient population. Until recently, no clinical tool existed to accurately estimate risk. Using a retrospective cohort of inpatients with acute stroke with an indication for anticoagulation, we found that age, infarct volume, and renal impairment are important predictors of HT. We created a Hemorrhage Risk Stratification (HeRS) score using these factors, specifically for the inpatient population, to allow physicians to quickly and accurately predict their patient’s individual risk of hemorrhagic conversion. This is useful not only to inform the clinical team and the patient of the expected risk, but also to guide treatment decisions. The HeRS score has been prospectively validated in a unique prospectively recruited inpatient cohort.
In collaboration with information technologist Peter Dziedzic, we have created an application available on iTunes that allows for quick and easy calculation of a patient’s HeRS score. The score provides a clinically useful and quantifiable risk estimate for hemorrhagic transformation in patients warranting anticoagulation, and may be used to guide treatment decisions when the need for anticoagulation is less clear.
Honors
Clinician Scientist Award, Johns Hopkins, 1/1/12
Memberships
- American Heart Association,
Fellow of the American Heart Association (FAHA)
- American Academy of Neurology
- American Neurological Association
Locations
- Johns Hopkins Bayview Medical Center
- 4940 Eastern Avenue, Suite 1201, Baltimore, MD 21224
- phone: 410-550-5624
- fax: 410-550-7694
Expertise
Education
Johns Hopkins University School of Medicine
Fellowship, Neurology, 2012Johns Hopkins University School of Medicine
Residency, Neurology, 2011Johns Hopkins University School of Medicine
Medical Education, MD, 2007Board Certifications
Vascular Neurology
American Board of Psychiatry and Neurology, 2012Neurology
American Board of Psychiatry and Neurology, 2011Insurance
- Aetna
- CareFirst
- Cigna
- First Health
- Geisinger Health Plan
- HealthSmart/Accel
- Humana
- Johns Hopkins Health Plans
- MultiPlan
- Pennsylvania's Preferred Health Networks (PPHN)
- Point Comfort Underwriters
- Private Healthcare Systems (PHCS)
- UnitedHealthcare
- Veteran Affairs Community Care Network (Optum-VACCN)
Ratings & Reviews
4.9 out of 5
47 ratings, 26 reviewsThe Patient Rating score is an average of all responses to physician related questions on the national CG-CAHPS Medical Practice patient experience survey through Press Ganey. Responses are measured on a scale of 1 to 5, with 5 being the best score. Comments are also gathered from our CG-CAHPS Medical Practice Survey through Press Ganey and displayed in their entirety. Patients are de-identified for confidentiality and patient privacy.
- 5 out of 5 starsReviewed on 11/20/2024
Polite professional
- 5 out of 5 starsReviewed on 11/20/2024
Dr. Marsh is the best. She listens and tries very hard to understand anything that is said. She brings much info into our conversations. She makes me feel very comfortable.
- 5 out of 5 starsReviewed on 11/13/2024
Very understanding of my condition
- 5 out of 5 starsReviewed on 11/6/2024
She was very kind and knowledgeable
- 5 out of 5 starsReviewed on 10/30/2024
Provider was good & smart, knows her stuffs
- 5 out of 5 starsReviewed on 10/23/2024
She is on point, direct but compassionate and caring. Does not make one feel rushed even though the visit was brief. Listen to concerns, even about treatment, without judgement.
- 5 out of 5 starsReviewed on 10/9/2024
Dr. Marsh is an excellent listener who provides helpful guidance in response to every question (regardless of how poorly formed the question might be).
- 5 out of 5 starsReviewed on 10/9/2024
Great experience with the doctor, she had a very pleasant attitude, was very easy to talk to, she listened and took her time with mr.
- 5 out of 5 starsReviewed on 10/9/2024
I came in for a second opinion following a cryptogenic stroke. My only real issue was it took 7 months before I could get into the office.
- 5 out of 5 starsReviewed on 9/25/2024
This was my first visit with Dr. Marsh. We found her to be very efficient and caring. She advised us on how to improve my current issues, and sent me for imaging to further understand what might be going on.
- 5 out of 5 starsReviewed on 9/4/2024
Dr. Marsh is a nationally renowned expert on stroke recovery and it is evident in her knowledge, demeanor, and confidence. She is wonderful to talk to and listens and answers all the questions, even those that are not easy.
- 5 out of 5 starsReviewed on 9/4/2024
Excellent listener-did not appear to be rushed.Very friendly. Thorough and knowledgeable.
- 5 out of 5 starsReviewed on 8/28/2024
SHE IS THE BEST PHYSICIAN I EVER HAD. SHE WAS PATIENT , KIND, AGOOD LISTENER, UNDESTANDING AND CARING. SHE REALIZED THAT I NEEDED A GOOD PRIMARY CARE PHYSICIAN AND SUGGESTED WHERE I COULD FIND SUCH A PHYSICIAN. SHE ENCOURAGED ME TO DO SO ASAP.
- 5 out of 5 starsReviewed on 8/21/2024
Dr Marsh is so professional and caring , alleviating all my concerns.
- 5 out of 5 starsReviewed on 7/10/2024
Polite, intelligent, kind, caring, and very informed about her area of expertise,
- 5 out of 5 starsReviewed on 6/19/2024
Dr Marsh is what a Doctor should be. She is a treasure.
- 5 out of 5 starsReviewed on 6/12/2024
Dr Marsh is the very best
- 5 out of 5 starsReviewed on 5/15/2024
She was very nice and interested in my health.
- 5 out of 5 starsReviewed on 5/8/2024
Dr Marsh is always listening to my concerns and makes me feel better about them.
- 5 out of 5 starsReviewed on 5/8/2024
Very thorough, nice and professional
- 5 out of 5 starsReviewed on 5/1/2024
Everyone was wonderful. Dr. Marsh is the best
- 5 out of 5 starsReviewed on 4/3/2024
This matter was a referral for a condition in which she is a expert. She discussed my records and MRI results In a very clear manner, we discussed my history and next steps all in a very understandable and Informative way. A very productive visitl
- 5 out of 5 starsReviewed on 3/4/2024
Dr. Marsh listens carefully and cares deeply about my condition.
- 5 out of 5 starsReviewed on 3/4/2024
Listens to my concerns, excellent bedside manner
- 5 out of 5 starsReviewed on 1/24/2024
Dr Marsh is the best doctor amongst my various doctors. She spends the time to listen to me, is empathetic, and is determined to give me the best possible healthcare.
- 5 out of 5 starsReviewed on 1/10/2024
Dr Marsh is fabulous. She provides excellent information, skill [name] knowledge while listening and answering questions.