Medical complications of stroke

Adrian Marchidann MD (Dr. Marchidann of SUNY Health Science Center has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released June 7, 2001; last updated March 14, 2017; expires March 14, 2020

Overview

Medical complications following stroke account for significant morbidity and mortality. These clinical conditions need to be recognized and managed effectively for a more favorable outcome. Direct effects of ischemic stroke account for most deaths within the first week. Other medical complications that include cardiac abnormalities, infections, and venous thromboembolism increase mortality thereafter. These clinical conditions need to be recognized and managed effectively for a more favorable outcome. In this article, the author discusses the medical complications of stroke-related deficits, their workup, and treatment modalities.

Key points

 

• Venous thromboembolism is one of the most common and potentially dangerous complications in patients with stroke because of impaired limb mobility, and in the case of intracerebral hemorrhage, of concerns regarding early anticoagulation.

 

• Although promising, the newer oral anticoagulation agents like rivaroxaban, apixaban, and dabigatran need further testing before stronger recommendations are made for their use as anticoagulants of choice.

 

• In the context of acute ischemic or hemorrhagic stroke, treatment of hemodynamically unstable pulmonary embolism requires specialized care and resources because the treatment of choice, intravenous thrombolysis, is contraindicated.

 

• Due to limited mobility, stroke is associated with increased risk of osteoporosis, fractures, pressure sores, painful arthritis, and peripheral neuropathy.

 

• Post-stroke pain is a severely debilitating symptom. Although numerous medications may help control the pain, they are often ineffective. Invasive neurosurgical and noninvasive transcranial magnetic stimulation methods have been developed to improve control of refractory central pain; however, more rigorous testing is needed.

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