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Complications During Hospitalization
During the stroke patient’s stay in the hospital,
the major concern is to limit the neurologic deficit due
to the acute stroke by placing patients on the proper treatments
to prevent the reoccurrence of strokes. In addition, prevention
of complications from the acute stroke is also a major concern.
Complications may include hemorrhagic transformation, ischemic
cerebral edema, infections, venous thrombosis, or pulmonary
embolisms.
HEMORRHAGIC
TRANSFORMATION
Definition:
Reperfusion of blood into ischemic tissue after an embolic
event. May occur 1-2 days after infarction.
Signs/Symptoms:
Neurologic worsening and perhaps gradual loss of consciousness,
head
pain, dizziness, or neck rigidity.
Diagnostic Tests:
CT scan
Treatment Options:
Preventive Therapy:
Control blood pressure. Avoid early use of anticoagulants
in large infarcts
Surgical Management:
Removal of clot by aspiration or evacuation if clot is
close to surface of the brain (acute stages)
ISCHEMIC
CEREBRAL EDEMA/PRESSURE
Definition:
Commonly occurring in large MCA infarctions, it is the development
of profuse quantities of fluid collecting in brain tissue
due to cellular swelling, breakdown of the blood-brain barrier,
cerebrospinal fluid exuding from ependymal lining, or materials
of blood clots or tissue injury creating an osmotic environment
allowing the movement of water into interstitial spaces.
Signs/Symptoms:
Neurological worsening, gradual loss of consciousness, headache,
dizziness
Diagnostic Test:
CT scan
Treatment Options:
Nonpharmacologic:
Hyperventilation, head elevation, maintenance of venous
outflow, drainage of cerebrospinal fluid, hemicraniectomy
Pharmacologic:
Mannitol
Use:
Reduce increased intracranial pressure due to cerebral
edema
MOA:
Causes water to be drawn from cells to extracellular
fluid and from erythrocytes to plasma
Dose:
0.25 – 2g/kg IV over 30-60 minutes every 4-8 hours until
serum osmolality between 300-310 mOsm/L is achieved.
(Pressure may be reduced within 15 minutes after start
of infusion.)
Monitoring:
renal function, urine output, fluid balance, sodium
and potassium concentration, central venous pressure
Adverse reactions:
headache, nausea, vomiting, polyuria, dehydration
Dosage forms:
15, 20, or 25% solutions
Investigative pharmacological options:
glycerol, hypertonic saline, urea, barbiturates
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Stroke Education
