Skip to main content

Advertisement

Log in

Early complications of ischemic stroke

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Patients with acute ischemic stroke are at high risk of neurologic and medical complications, such as space-occupying edema formation, hemorrhagic transformation of the infarct, epileptic seizures, depression, and venous thromboembolism. They should therefore be monitored closely for early detection of these complications. Care is best when the patient is admitted to a specialized stroke unit. The multidisciplinary approach provided by stroke units, including specialized medical, nursing, and remedial therapies, reduces the duration of hospitalization and improves functional outcome. For many complications, however, optimal treatment and its effect on functional outcome after stroke has not been established. Therefore, in addition to the ongoing acute intervention trials, well-designed, large randomized trials are needed to address the prevention and treatment of complications and their effect on functional outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Feigin VL, Lawes CM, Bennett DA, Anderson CS: Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003, 2:43–53.

    Article  PubMed  Google Scholar 

  2. van der Worp HB, Van Gijn J: Clinical practice. Acute ischemic stroke. N Engl J Med 2007, 357:572–579.

    Article  PubMed  Google Scholar 

  3. Indredavik B, Rohweder G, Naalsund E, Lydersen S: Medical complications in a comprehensive stroke unit and an early supported discharge service. Stroke 2008, 39:414–420.

    Article  PubMed  Google Scholar 

  4. Hacke W, Schwab S, Horn M, et al.: “Malignant” middle cerebral artery infarction. Clinical course and prognostic signs. Arch Neurol 1996, 53:309–315.

    PubMed  CAS  Google Scholar 

  5. Hofmeijer J, Algra A, Kappelle LJ, van der Worp HB: Predictors of life-threatening brain edema in middle cerebral artery infarction. Cerebrovasc Dis 2008, 25:176–184.

    Article  PubMed  Google Scholar 

  6. Oppenheim C, Samson Y, Manai R, et al.: Prediction of malignant middle cerebral artery infarction by diffusionweighted imaging. Stroke 2000, 31:2175–2181.

    PubMed  CAS  Google Scholar 

  7. Thomalla GJ, Kucinski T, Schoder V, et al.: Prediction of malignant middle cerebral artery infarction by early per fusion-and diffusion-weighted magnetic resonance imaging. Stroke 2003, 34:1892–1899.

    Article  PubMed  Google Scholar 

  8. Hofmeijer J, van der Worp HB, Kappelle LJ: Treatment of space-occupying hemispheric infarction. Crit Care Med 2003, 31:617–625.

    Article  PubMed  Google Scholar 

  9. Vahedi K, Hofmeijer J, Juettler E, et al.: Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007, 6:215–222.

    Article  PubMed  Google Scholar 

  10. Mayer TE, Schulte-Altedorneburg G, Droste DW, Brückmann H: Serial CT and MRI of ischaemic cerebral infarcts: frequency and clinical impact of haemorrhagic transformation. Neuroradiology 2000, 42:233–239.

    Article  PubMed  CAS  Google Scholar 

  11. Hart RG, Easton JD: Hemorrhagic infarcts. Stroke 1986, 17:586–589.

    PubMed  CAS  Google Scholar 

  12. Molina CA, Alvarez-Sabin J, Montaner J, et al.: Thrombolysis-related hemorrhagic infarction: a marker of early reperfusion, reduced infarct size, and improved outcome in patients with proximal middle cerebral artery occlusion. Stroke 2002, 33:1551–1556.

    Article  PubMed  Google Scholar 

  13. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995, 333:1581–1587.

    Article  Google Scholar 

  14. Camilo O, Goldstein LB: Seizures and epilepsy after ischemic stroke. Stroke 2004, 35:1769–1775.

    Article  PubMed  Google Scholar 

  15. Szaflarski JP, Rackley AY, Kleindorfer DO, et al.: Incidence of seizures in the acute phase of stroke: a population-based study. Epilepsia 2008, 49:974–981.

    Article  PubMed  Google Scholar 

  16. Adams HP Jr, del Zoppo G, Alberts MJ, et al.: Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke 2007, 38:1655–1711.

    Article  PubMed  Google Scholar 

  17. Khechinashvili G, Asplund K: Electrocardiographic changes in patients with acute stroke: a systematic review. Cerebrovasc Dis 2002, 14:67–76.

    Article  PubMed  Google Scholar 

  18. Ngeh JK: A case-control study on the prevalence of electrocardiographic rhythms and ischemic changes in elderly patients with acute cerebrovascular disease. Am J Geriatr Cardiol 2004, 13:248–251.

    Article  PubMed  Google Scholar 

  19. Abboud H, Berroir S, Labreuche J, et al.: Insular involvement in brain infarction increases risk for cardiac arrhythmia and death. Ann Neurol 2006, 59:691–699.

    Article  PubMed  Google Scholar 

  20. Hart RG, Aguilar MI: Anticoagulation in atrial fibrillation: selected controversies including optimal anticoagulation intensity, treatment of intracerebral hemorrhage. J Thromb Thrombolysis 2008, 25:26–32.

    Article  PubMed  CAS  Google Scholar 

  21. Willmot M, Leonardi-Bee J, Bath PM: High blood pressure in acute stroke and subsequent outcome: a systematic review. Hypertension 2004, 43:18–24.

    Article  PubMed  CAS  Google Scholar 

  22. Qureshi AI: Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation 2008, 118:176–187.

    Article  PubMed  Google Scholar 

  23. Leonardi-Bee J, Bath PM, Phillips SJ, Sandercock PA: Blood pressure and clinical outcomes in the International Stroke Trial. Stroke 2002, 33:1315–1320.

    Article  PubMed  Google Scholar 

  24. Kelly J, Rudd A, Lewis R, Hunt BJ: Venous thromboembolism after acute stroke. Stroke 2001, 32:262–267.

    PubMed  CAS  Google Scholar 

  25. den Hertog H, van der Worp B, van Gemert M, Dippel D: Therapeutic hypothermia in acute ischemic stroke. Expert Rev Neurother 2007, 7:155–164.

    Article  Google Scholar 

  26. Reith J, Jørgensen S, Pedersen PM, et al.: Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet 1996, 347:422–425.

    Article  PubMed  CAS  Google Scholar 

  27. den Hertog MH, van der Worp HB, Tseng M, Dippel DWJ: Cooling therapy for acute stroke. Cochrane Database Syst Rev 2008 (in press).

  28. van Breda EJ, van der Worp HB, van Gemert HM, et al.: PAIS: paracetamol (acetaminophen) in stroke, protocol for a randomized, double blind clinical trial [ISCRTN 74418480]. BMC Cardiovasc Disord 2005, 5:24.

    Article  PubMed  Google Scholar 

  29. Emsley HC, Hopkins SJ: Acute ischaemic stroke and infection: recent and emerging concepts. Lancet Neurol 2008, 7:341–353.

    Article  PubMed  Google Scholar 

  30. Capes SE, Hunt D, Malmberg K, et al.: Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001, 32:2426–2432.

    Article  PubMed  CAS  Google Scholar 

  31. Gray CS, Hildreth AJ, Sandercock PA, et al.: Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol 2007, 6:397–406.

    Article  PubMed  CAS  Google Scholar 

  32. Carnaby G, Hankey GJ, Pizzi J: Behavioural intervention for dysphagia in acute stroke: a randomized controlled trial. Lancet Neurol 2006, 5:31–37.

    Article  PubMed  Google Scholar 

  33. Dennis MS, Lewis SC, Warlow C: Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. Lancet 2005, 365:755–763.

    Article  PubMed  CAS  Google Scholar 

  34. Dennis MS, Lewis SC, Warlow C: Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet 2005, 365:764–772.

    Article  PubMed  CAS  Google Scholar 

  35. Nys GM, van Zandvoort MJ, van der Worp HB, et al.: Early depressive symptoms after stroke: neuropsychological correlates and lesion characteristics. J Neurol Sci 2005, 228:27–33.

    Article  PubMed  CAS  Google Scholar 

  36. Gaete JM, Bogousslavsky J: Post-stroke depression. Expert Rev Neurother 2008, 8:75–92.

    Article  PubMed  Google Scholar 

  37. Chen Y, Patel NC, Guo JJ, Zhan S: Antidepressant prophylaxis for poststroke depression: a meta-analysis. Int Clin Psychopharmacol 2007, 22:159–166.

    Article  PubMed  Google Scholar 

  38. Oldenbeuving AW, de Kort PLM, Jansen BPW, et al.: Delirium in acute stroke: a review. Int J Stroke 2007, 2:270–275.

    Article  PubMed  CAS  Google Scholar 

  39. Inouye SK: Delirium in older persons. N Engl J Med 2006, 354:1157–1165.

    Article  PubMed  CAS  Google Scholar 

  40. Pettersen R, Wyller TB: Prognostic significance of micturition disturbances after acute stroke. J Am Geriatr Soc 2006, 54:1878–1884.

    Article  PubMed  Google Scholar 

  41. Thomas LH, Cross S, Barrett J, et al.: Treatment of urinary incontinence after stroke in adults. Cochrane Database Syst Rev 2008, CD004462.

  42. Kumar A, Dromerick AW: Intractable hiccups during stroke rehabilitation. Arch Phys Med Rehabil 1998, 79:697–699.

    Article  PubMed  CAS  Google Scholar 

  43. Park MH, Kim BJ, Koh SB, et al.: Lesional location of lateral medullary infarction presenting hiccups (singultus). J Neurol Neurosurg Psychiatry 2005, 76:95–98.

    Article  PubMed  CAS  Google Scholar 

  44. Schuchmann JA, Browne BA: Persistent hiccups during rehabilitation hospitalization: three case reports and review of the literature. Am J Phys Med Rehabil 2007, 86:1013–1018.

    Article  PubMed  Google Scholar 

  45. Paci M, Nannetti L, Taiti P, et al.: Shoulder subluxation after stroke: relationships with pain and motor recovery. Physiother Res Int 2007, 12:95–104.

    Article  PubMed  Google Scholar 

  46. Griffin A, Bernhardt J: Strapping the hemiplegic shoulder prevents development of pain during rehabilitation: a randomized controlled trial. Clin Rehabil 2006, 20:287–295.

    Article  PubMed  Google Scholar 

  47. Hanger HC, Whitewood P, Brown G, et al.: A randomized controlled trial of strapping to prevent post-stroke shoulder pain. Clin Rehabil 2000, 14:370–380.

    Article  PubMed  CAS  Google Scholar 

  48. Capon A, Pavoni N, Mastromattei A, Di Lallo D: Pressure ulcer risk in long-term units: prevalence and associated factors. J Adv Nurs 2007, 58:263–272.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to H. Bart van der Worp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bart van der Worp, H., Dianne Raaijmakers, T.W.M. & Jaap Kappelle, L. Early complications of ischemic stroke. Curr Treat Options Neurol 10, 440–449 (2008). https://doi.org/10.1007/s11940-008-0046-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-008-0046-5

Keywords

Navigation