Management of Acute Stroke Complication

Jongmin Lee

doi:10.5124/jkma.2009.52.4.365

J Korean Med Assoc > Volume 52(4); 2009 > Article

Lee: Management of Acute Stroke Complication

Focused Issue of This Month

Acute Management of Stroke

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2009; 52(4): 365-374.

Published online: April 30, 2009

DOI: http://dx.doi.org/10.5124/jkma.2009.52.4.365

Management of Acute Stroke Complication

Jongmin Lee, MD

Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea. leej@kku.ac.kr

Abstract

Acute complications following stroke may increase mortality and impede functional recovery. Most of the complications are treatable and preventable. Close monitoring of the complications and proper management are necessary for the better outcome of the patients. Common complications include aspiration pneumonia, dysphagia, urinary tract infection, incontinence, malnutrition, deep vein thrombosis, pressure sore, fall, pain, seizure, and depression. Proper positioning and early mobilization are recommended to prevent major complications. Aspiration pneumonia is one of the frequent causes of death in acute stroke setting. Dysphagia screening should be done to evaluate the risk of aspiration. If oral feeding is not safe, nasogastric tube feeding should be considered. The majority of urinary tract infections in acute stroke are associated with the use of indwelling catheters, therefore prolonged indwelling catheterization should be avoided. Nutritional assessment and supplements are necessary in acute stroke patients. Low dose subcutaneous heparin or low molecular weight heparin should be considered for patients with high risk of deep vein thrombosis. If heparin is contraindicated, compressive stockings are an alternative. Regular assessment for skin breakdown and fall risk is recommended for all patients. Shoulder pain is also one of the frequent complications in stroke patients. Proper handling and mobilization in acute stage may prevent shoulder pain. Administration of anticonvulsants may prevent recurrent post-stroke seizures. Depression may limit functional outcome by inhibiting patient motivation and treatment with antidepressants should be considered. Proper management of acute complications needs multidisciplinary team approach that consists of physicians, nurses, therapists, and nutritionists. Adequate prevention and management of complications may improve functional outcome of acute stroke.

Complications; Acute stroke; Management

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Table 1

Frequencies of acute complications following stroke

^* Data taken from (3~13).

Table 2

AHA/ASA-endorsed guidelines for assessment of swallowing

^*Recommendation level

A: a strong recommendation that the intervention is always indicated and acceptable, B: a recommendation that the intervention may be useful/effective, C: a recommendation that the intervention may be considered, D: a recommendation that a procedure may be considered not useful/effective, or may be harmful, I: Insufficient evidence to recommend for or against; clinical judgment should be used.

Table 3

AHA/ASA-endorsed guidelines for prevention of deep vein thrombosis

^*Recommendation level

Table 4

Braden scale for predicting pressure sore risk

Table 5

AHA/ASA-endorsed guidelines for prevention of pressure ulcer

^*Recommendation level

A: a strong recommendation that the intervention is always indicated and acceptable, B: a recommendation that the intervention may be useful/effective, C: a recommendation that the intervention may be considered, D: a recommendation that a procedure may be considered not useful/effective, or may be harmful, I: Insufficient evidence to reco-mmend for or against; clinical judgment should be used.