Acute Stroke Diagnosis and Treatment

Under the direction of Robert Wityk, M.D.

Our research here focuses on the complex issue of blood pressure management in patients with acute ischemic stroke due to blocked blood vessels. While we know that long-term treatment of chronic hypertension is good in terms of preventing stroke, we also know from experience that lowering blood pressure rapidly in someone having an acute stroke can make them worse. In the first few hours to one day after the start of a stroke, the brain is trying to maintain blood flow.  One mechanism that the body uses to accomplish this is to spontaneously raise blood pressure.

We have been looking at using this natural response to stroke as a means of improving blood flow to the brain in other patients. Certain intravenous medications are commonly used by anesthesiologists and neuro-intensivists to gradually elevate blood pressure for a variety of reasons. We are investigating if elevating the blood pressure of certain stroke patients to a moderate degree and for a short period of time might help them regain some function. These treatments are carried out with intensive neurological monitoring in the Neuro Critical Care Unit at The Johns Hopkins Hospital or the 8-bed unit at the Johns Hopkins Bayview Medical Center with the assistance of an experienced staff of neurology / critical care physicians and nurses.

Our preliminary results using sophisticated MRI studies suggest that patients who have regions of the brain that are not receiving enough blood, but are not irreversibly damaged, can show rapid improvement in terms of movement, language or visual abilities when blood pressure is carefully elevated. These results have led to a multicenter pilot clinical trial at Hopkins as well as other institutions in Baltimore and Boston.