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Our Approach to Stroke Care at Johns Hopkins

A woman doctor teleconferencing with colleagues about a stroke patient

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


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. T 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, 76% 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 12 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 is now 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 thrombectomyendovascular 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 6 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.
    A team of physicians see stroke patients every weekday. 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.



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.

The SQUID Trial for the Embolization of the Middle Meningeal Artery (STEM) for Treatment of Chronic Subdural Hematoma (IRB00253687)

Principle Investigator: Justin Caplan, M.D.
Contact: Whitney Isennock (, 667-306-8145)
Summary: To test the safety and efficacy (how well it works) of embolization to treat MMA bleeds using SQUID™ in surgically treated and non-surgically treated patients with cSDH.
Eligibility Criteria: People who have been diagnosed with chronic bleeding between the hard-cerebral membrane and the brain, also known as chronic subdural hematoma (“cSDH”) may join this study.
More information on NCT04410146

OPTIMIST: Optimal Post Tpa-IV Monitoring in Ischemic Stroke

Principle Investigator: Victor Urrutia, M.D.
Summary: To show safety of post-tPA monitoring in a non-ICU setting for patients presenting with minor stroke symptoms (NIHSS<10)
Major inclusion criteria:

  • Patients receiving IV tPA for presumed stroke within 4.5 hours of symptom onset
  • NIHSS <10 at presentation and at the end of tPA infusion
  • Age 18-80 years
  • Patients do not have ICU needs by the end of the tPA infusion

Major exclusion criteria:

  • Age <17 or >80
  • ICU need or indication by the end of the tPA infusion
  • NIHSS >9 at presentation or at the end of the tPA infusion

Proceedings: At the end of the one-hour tPA infusion, eligible patients will be consented for this study and will continue with neurocheck and vital signs Q 15 minutes x 4 in the ED. The patient may transfer to the BRU after the third Q 15-minute interval, so that they receive the 4th in the BRU. After arrival to the BRU, they will receive a set of vital signs and neurochecks upon arrival and at one hour, then Q 2 hours for 8 hours and then Q 4 hours until completing the 24-hour post tPA.

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