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Neurology and Neurosurgery

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Emergency Stroke Services

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.

Endovascular Techniques
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.

Brain Attack Team (BAT Calls)
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. 

Diagnostic Testing
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.

Swallow Screening
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).

NIHSS NIH Stroke Scale 
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.

Vascular Neurosurgical and Neurointerventional Procedures
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).

Management of Increased Intracranial Pressure (ICP)
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.

For more information, contact The Johns Hopkins Hospital Stroke Center at 410-955-2228.
Questions about the Stroke Prevention And Recovery Center? Please call 443-287-8514.

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Maryland Patients

To request an appointment or refer a patient, please call:
Neurology: 410-955-2228
Neurosurgery: 410-614-1533

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Adult Neurology: 410-955-9441
Pediatric Neurology: 410-955-4259
Adult Neurosurgery: 410-955-6406
Pediatric Neurosurgery: 410-955-7337


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