Complications
Motor weakness with lack of mobility causes venous stasis in the lower limbs, resulting in deep venous thrombosis. Prophylactic anticoagulation will reduce the risk of pulmonary embolism.[195][196] Intermittent pneumatic compression of the legs is recommended to reduce the risk of DVT in non-ambulatory stroke patients.[69][196]
Orolingual oedema can rarely complicate the use of alteplase. In most cases, patients improve after alteplase treatment has been stopped and antihistamines and corticosteroids have been given. Sometimes orolingual oedema involves the upper airways extensively, leading to severe respiratory distress. Referral to an anaesthetist is required in these cases.
Depression is common after stroke, and may warrant treatment with psychotherapy or antidepressant medicines.[194]
At least half of all stroke survivors experience fatigue.[197]
Post-stroke fatigue affects quality of life and exerts a negative impact on a patient’s daily activities, such as decreased participation in physical activities and rehabilitation.[197] People with stroke should be assessed and periodically reviewed for post-stroke fatigue, including for factors that might precipitate or exacerbate fatigue (e.g., depression and anxiety, sleep disorders, pain) and these factors should be addressed accordingly. Appropriate time points for review are at discharge from hospital and then at regular intervals, including at 6 months and annually thereafter.[68]
Stroke-related dysphagia results in aspiration and subsequent pneumonia. On admission, ensure the patient has their swallowing function assessed by appropriately trained staff before being given any oral food, fluid, or medication.[67]
If the admission screen indicates problems with swallowing, ensure specialist assessment within 24 hours of admission (preferably) and not more than 72 hours afterwards.
To avoid aspiration pneumonia, give food, fluids, and medication to people with dysphagia in a form that can be swallowed without aspiration, after specialist assessment of swallowing.[67]
When aspiration pneumonia occurs, the pneumonia should be treated with antibiotics and consideration given to whether enteral feeding is indicated.[69]
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