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Supportive Care and Management of Inhospital Complications

  • Chapter
Ischemic Stroke Therapeutics

Abstract

Acute ischemic strokes are the result of complications of medical diseases. The primary goal of hospitalization is to treat the acute problem, to find the etiology of stroke, to develop a secondary prevention plan, to prevent complications, and to treat complications that arise. The medical management of patients with an acute cerebrovascular event becomes more complex when each of these is considered. The balance of risks and benefits should be assessed with each treatment decision. The major neurologic complications that may result include reperfusion injury and cerebral edema among others.

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References

  1. Davalos A, Cendra E, Teruel J, Martinez M, Genis D. Deteriorating ischemic stroke: risk factors and prognosis. Neurology. 1990;40(12):1865–9.

    Article  CAS  PubMed  Google Scholar 

  2. Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Martin-Schild S. What change in the National Institutes of Health Stroke Scale should define neurologic deterioration in acute ischemic stroke? J Stroke Cerebrovasc Dis. 2013;22(5):675–82.

    Article  PubMed  Google Scholar 

  3. Ntaios G, Lambrou D, Cuendet D, Michel P. Early major worsening in ischemic stroke: predictors and outcome. Neurocrit Care. 2013;19:287.

    Article  CAS  PubMed  Google Scholar 

  4. Johnston SC, Leira EC, Hansen MD, Adams Jr HP. Early recovery after cerebral ischemia risk of subsequent neurological deterioration. Ann Neurol. 2003;54(4):439–44.

    Article  PubMed  Google Scholar 

  5. Grotta JC, Welch KM, Fagan SC, Lu M, Frankel MR, Brott T, et al. Clinical deterioration following improvement in the NINDS rt-PA Stroke Trial. Stroke. 2001;32(3):661–8.

    Article  CAS  PubMed  Google Scholar 

  6. Alexandrov AV, Felberg RA, Demchuk AM, Christou I, Burgin WS, Malkoff M, et al. Deterioration following spontaneous improvement: sonographic findings in patients with acutely resolving symptoms of cerebral ischemia. Stroke. 2000;31(4):915–9.

    Article  CAS  PubMed  Google Scholar 

  7. Alexandrov AV, Grotta JC. Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator. Neurology. 2002;59(6):862–7.

    Article  CAS  PubMed  Google Scholar 

  8. Manno EM, Nichols DA, Fulgham JR, Wijdicks EF. Computed tomographic determinants of neurologic deterioration in patients with large middle cerebral artery infarctions. Mayo Clin Proc. 2003;78(2):156–60.

    Article  PubMed  Google Scholar 

  9. Miyamoto N, Tanaka Y, Ueno Y, Kawamura M, Shimada Y, Tanaka R, et al. Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis. 2013;22(3):205–10.

    Article  PubMed  Google Scholar 

  10. Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996;53(4):309–15.

    Article  CAS  PubMed  Google Scholar 

  11. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, 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(3):215–22.

    Article  PubMed  Google Scholar 

  12. Bereczki D, Fekete I, Prado GF, Liu M. Mannitol for acute stroke. Cochrane Database Syst Rev. 2007; (3):CD001153.

    Google Scholar 

  13. Sandercock PA, Soane T. Corticosteroids for acute ischaemic stroke. Cochrane Database Syst Rev. 2011; (9):CD000064.

    Google Scholar 

  14. Horn CM, Sun CH, Nogueira RG, Patel VN, Krishnan A, Glenn BA, et al. Endovascular Reperfusion and Cooling in Cerebral Acute Ischemia (ReCCLAIM I). J Neurointerv Surg. 2014;6(2):91–5.

    Article  PubMed  Google Scholar 

  15. Khatri R, McKinney AM, Swenson B, Janardhan V. Blood-brain barrier, reperfusion injury, and hemorrhagic transformation in acute ischemic stroke. Neurology. 2012;79(13 Suppl 1):S52–7.

    Article  PubMed  Google Scholar 

  16. Larrue V, von Kummer RR, Muller A, Bluhmki E. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II). Stroke. 2001;32(2):438–41.

    Article  CAS  PubMed  Google Scholar 

  17. Mazya M, Egido JA, Ford GA, Lees KR, Mikulik R, Toni D, et al. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score. Stroke. 2012;43(6):1524–31.

    Article  CAS  PubMed  Google Scholar 

  18. Saver JL. Number needed to treat estimates incorporating effects over the entire range of clinical outcomes: novel derivation method and application to thrombolytic therapy for acute stroke. Arch Neurol. 2004;61(7):1066–70.

    Article  PubMed  Google Scholar 

  19. Saver JL. Hemorrhage after thrombolytic therapy for stroke: the clinically relevant number needed to harm. Stroke. 2007;38(8):2279–83.

    Article  CAS  PubMed  Google Scholar 

  20. Weiser RE, Sheth KN. Clinical predictors and management of hemorrhagic transformation. Curr Treat Options Neurol. 2013;15(2):125–49.

    Article  PubMed  Google Scholar 

  21. Forsgren L, Bucht G, Eriksson S, Bergmark L. Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia. 1996;37(3):224–9.

    Article  CAS  PubMed  Google Scholar 

  22. Gupta SR, Naheedy MH, Elias D, Rubino FA. Postinfarction seizures. A clinical study. Stroke. 1988;19(12):1477–81.

    Article  CAS  PubMed  Google Scholar 

  23. French J, Gazzola D. Antiepileptic drug treatment: new drugs and new strategies. Minneapolis, MN: Continuum; 2013. p. 643–55.

    Google Scholar 

  24. Goldstein LB. Common drugs may influence motor recovery after stroke. The Sygen In Acute Stroke Study Investigators. Neurology. 1995;45(5):865–71.

    Article  CAS  PubMed  Google Scholar 

  25. Leker RR, Neufeld MY. Anti-epileptic drugs as possible neuroprotectants in cerebral ischemia. Brain Res Brain Res Rev. 2003;42(3):187–203.

    Article  CAS  PubMed  Google Scholar 

  26. Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke. 2005;36(6):1330–40.

    Article  PubMed  Google Scholar 

  27. Mead GE, Hsieh CF, Hackett M. Selective serotonin reuptake inhibitors for stroke recovery. JAMA. 2013;310(10):1066–7.

    Article  CAS  PubMed  Google Scholar 

  28. Oldenbeuving AW, de Kort PL, Jansen BP, Roks G, Kappelle LJ. Delirium in acute stroke: a review. Int J Stroke. 2007;2(4):270–5.

    Article  CAS  PubMed  Google Scholar 

  29. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell Jr FE, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753–62.

    Article  CAS  PubMed  Google Scholar 

  30. Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in acute stroke: a systematic review and meta-analysis. Stroke. 2012;43(3):645–9.

    Article  PubMed  Google Scholar 

  31. Mitasova A, Kostalova M, Bednarik J, Michalcakova R, Kasparek T, Balabanova P, et al. Poststroke delirium incidence and outcomes: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2012;40(2):484–90.

    Article  PubMed  Google Scholar 

  32. Oldenbeuving AW, de Kort PL, Jansen BP, Algra A, Kappelle LJ, Roks G. Delirium in the acute phase after stroke: incidence, risk factors, and outcome. Neurology. 2011;76(11):993–9.

    Article  CAS  PubMed  Google Scholar 

  33. Ryan M, Merrick EL, Hodgkin D, Horgan CM, Garnick DW, Panas L, et al. Drinking patterns of older adults with chronic medical conditions. J Gen Intern Med. 2013;28(10):1326–32.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Inouye SK. Delirium in older persons. N Engl J Med. 2006;354(11):1157–65.

    Article  CAS  PubMed  Google Scholar 

  35. Rea RS, Battistone S, Fong JJ, Devlin JW. Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. Pharmacotherapy. 2007;27(4):588–94.

    Article  CAS  PubMed  Google Scholar 

  36. Ahmed N, Wahlgren N, Brainin M, Castillo J, Ford GA, Kaste M, et al. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). Stroke. 2009;40(7):2442–9.

    Article  PubMed  Google Scholar 

  37. Sare GM, Ali M, Shuaib A, Bath PM. Relationship between hyperacute blood pressure and outcome after ischemic stroke: data from the VISTA collaboration. Stroke. 2009;40(6):2098–103.

    Article  PubMed  Google Scholar 

  38. Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.

    Article  PubMed  Google Scholar 

  39. Martin-Schild S, Hallevi H, Albright KC, Khaja AM, Barreto AD, Gonzales NR, et al. Aggressive blood pressure-lowering treatment before intravenous tissue plasminogen activator therapy in acute ischemic stroke. Arch Neurol. 2008;65(9):1174–8.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Liu-Deryke X, Janisse J, Coplin WM, Parker Jr D, Norris G, Rhoney DH. A comparison of nicardipine and labetalol for acute hypertension management following stroke. Neurocrit Care. 2008;9(2):167–76.

    Article  PubMed  CAS  Google Scholar 

  41. Liu-Deryke X, Levy PD, Parker Jr D, Coplin W, Rhoney DH. A prospective evaluation of labetalol versus nicardipine for blood pressure management in patients with acute stroke. Neurocrit Care. 2013;19(1):41–7.

    Article  CAS  PubMed  Google Scholar 

  42. He J, Zhang Y, Xu T, Zhao Q, Wang D, Chen CS, et al. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial. JAMA. 2014;311(5):479–89.

    Article  CAS  PubMed  Google Scholar 

  43. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet. 2000;355(9200):253–9.

    Google Scholar 

  44. Klijn CJ, Kappelle LJ. Haemodynamic stroke: clinical features, prognosis, and management. Lancet Neurol. 2010;9(10):1008–17.

    Article  PubMed  Google Scholar 

  45. Lewis WR, Fonarow GC, Grau-Sepulveda MV, Smith EE, Bhatt DL, Hernandez AF, et al. Improvement in use of anticoagulation therapy in patients with ischemic stroke: results from get with the guidelines-stroke. Am Heart J. 2011;162(4):692–9.e2.

    Article  PubMed  Google Scholar 

  46. Rizos T, Wagner A, Jenetzky E, Ringleb PA, Becker R, Hacke W, et al. Paroxysmal atrial fibrillation is more prevalent than persistent atrial fibrillation in acute stroke and transient ischemic attack patients. Cerebrovasc Dis. 2011;32(3):276–82.

    CAS  PubMed  Google Scholar 

  47. Kamel H, Elkind MS, Bhave PD, Navi BB, Okin PM, Iadecola C, et al. Paroxysmal supraventricular tachycardia and the risk of ischemic stroke. Stroke. 2013;44(6):1550–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Kamel H, Lees KR, Lyden PD, Teal PA, Shuaib A, Ali M, et al. Delayed detection of atrial fibrillation after ischemic stroke. J Stroke Cerebrovasc Dis. 2009;18(6):453–7.

    Article  PubMed  Google Scholar 

  49. Elijovich L, Josephson SA, Fung GL, Smith WS. Intermittent atrial fibrillation may account for a large proportion of otherwise cryptogenic stroke: a study of 30-day cardiac event monitors. J Stroke Cerebrovasc Dis. 2009;18(3):185–9.

    Article  PubMed  Google Scholar 

  50. Gladstone DJ, Bui E, Fang J, Laupacis A, Lindsay MP, Tu JV, et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke. 2009;40(1):235–40.

    Article  CAS  PubMed  Google Scholar 

  51. Ziegler PD, Glotzer TV, Daoud EG, Wyse DG, Singer DE, Ezekowitz MD, et al. Incidence of newly detected atrial arrhythmias via implantable devices in patients with a history of thromboembolic events. Stroke. 2010;41(2):256–60.

    Article  PubMed  Google Scholar 

  52. Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366(2):120–9.

    Article  CAS  PubMed  Google Scholar 

  53. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285(22):2864–70.

    Article  CAS  PubMed  Google Scholar 

  54. Turagam MK, Velagapudi P, Leal MA, Kocheril AG. Aspirin in stroke prevention in nonvalvular atrial fibrillation and stable vascular disease: an era of new anticoagulants. Expert Rev Cardiovasc Ther. 2012;10(4):433–9.

    Article  CAS  PubMed  Google Scholar 

  55. Lansberg MG, O’Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e601S–36.

    CAS  PubMed Central  PubMed  Google Scholar 

  56. Berge E, Abdelnoor M, Nakstad PH, Sandset PM. Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation: a double-blind randomised study. HAEST Study Group. Heparin in Acute Embolic Stroke Trial. Lancet. 2000;355(9211):1205–10.

    Article  CAS  PubMed  Google Scholar 

  57. Whiteley WN, Adams Jr HP, Bath PM, Berge E, Sandset PM, Dennis M, et al. Targeted use of heparin, heparinoids, or low-molecular-weight heparin to improve outcome after acute ischaemic stroke: an individual patient data meta-analysis of randomised controlled trials. Lancet Neurol. 2013;12(6):539–45.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Anders B, Alonso A, Artemis D, Schafer A, Ebert A, Kablau M, et al. What does elevated high-sensitive troponin I in stroke patients mean: concomitant acute myocardial infarction or a marker for high-risk patients? Cerebrovasc Dis. 2013;36(3):211–7.

    Article  CAS  PubMed  Google Scholar 

  59. Kerr G, Ray G, Wu O, Stott DJ, Langhorne P. Elevated troponin after stroke: a systematic review. Cerebrovasc Dis. 2009;28(3):220–6.

    Article  CAS  PubMed  Google Scholar 

  60. Jensen JK, Kristensen SR, Bak S, Atar D, Hoilund-Carlsen PF, Mickley H. Frequency and significance of troponin T elevation in acute ischemic stroke. Am J Cardiol. 2007;99(1):108–12.

    Article  CAS  PubMed  Google Scholar 

  61. Milhaud D, Popp J, Thouvenot E, Heroum C, Bonafe A. Mechanical ventilation in ischemic stroke. J Stroke Cerebrovasc Dis. 2004;13(4):183–8.

    Article  PubMed  Google Scholar 

  62. Mohsenin V. Sleep-related breathing disorders and risk of stroke. Stroke. 2001;32(6):1271–8.

    Article  CAS  PubMed  Google Scholar 

  63. Tsivgoulis G, Zhang Y, Alexandrov AW, Harrigan MR, Sisson A, Zhao L, et al. Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke. Stroke. 2011;42(4):1030–4.

    Article  PubMed  Google Scholar 

  64. Bosel J, Schiller P, Hook Y, Andes M, Neumann JO, Poli S, et al. Stroke-related Early Tracheostomy versus Prolonged Orotracheal Intubation in Neurocritical Care Trial (SETPOINT): a randomized pilot trial. Stroke. 2013;44(1):21–8.

    Article  PubMed  Google Scholar 

  65. Masrur S, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Zhao X, et al. Dysphagia screening and hospital-acquired pneumonia in patients with acute ischemic stroke: findings from get with the guidelines-stroke. J Stroke Cerebrovasc Dis. 2013;22:e301.

    Article  PubMed  Google Scholar 

  66. Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis. 2012;21(1):61–7.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Katzan IL, Dawson NV, Thomas CL, Votruba ME, Cebul RD. The cost of pneumonia after acute stroke. Neurology. 2007;68(22):1938–43.

    Article  CAS  PubMed  Google Scholar 

  68. Hannawi Y, Hannawi B, Rao CP, Suarez JI, Bershad EM. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis. 2013;35(5):430–43.

    Article  CAS  PubMed  Google Scholar 

  69. Hassan AE, Chaudhry SA, Zacharatos H, Khatri R, Akbar U, Suri MF, et al. Increased rate of aspiration pneumonia and poor discharge outcome among acute ischemic stroke patients following intubation for endovascular treatment. Neurocrit Care. 2012;16(2):246–50.

    Article  CAS  PubMed  Google Scholar 

  70. Daniels SK, Anderson JA, Willson PC. Valid items for screening dysphagia risk in patients with stroke: a systematic review. Stroke. 2012;43(3):892–7.

    Article  PubMed  Google Scholar 

  71. Falcone M, Venditti M, Shindo Y, Kollef MH. Healthcare-associated pneumonia: diagnostic criteria and distinction from community-acquired pneumonia. Int J Infect Dis. 2011;15(8):e545–50.

    Article  PubMed  Google Scholar 

  72. Davalos A, Ricart W, Gonzalez-Huix F, Soler S, Marrugat J, Molins A, et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke. 1996;27(6):1028–32.

    Article  CAS  PubMed  Google Scholar 

  73. Chalela JA, Haymore J, Schellinger PD, Kang DW, Warach S. Acute stroke patients are being underfed: a nitrogen balance study. Neurocrit Care. 2004;1(3):331–4.

    Article  PubMed  Google Scholar 

  74. Kumar S, Langmore S, Goddeau Jr RP, Alhazzani A, Selim M, Caplan LR, et al. Predictors of percutaneous endoscopic gastrostomy tube placement in patients with severe dysphagia from an acute-subacute hemispheric infarction. J Stroke Cerebrovasc Dis. 2012;21(2):114–20.

    Article  PubMed Central  PubMed  Google Scholar 

  75. Ginsberg MD, Palesch YY, Hill MD, Martin RH, Moy CS, Barsan WG, et al. High-dose albumin treatment for acute ischaemic stroke (ALIAS) Part 2: a randomised, double-blind, phase 3, placebo-controlled trial. Lancet Neurol. 2013;12(11):1049–58.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  76. Huang WY, Weng WC, Peng TI, Chien YY, Wu CL, Lee M, et al. Association of hyponatremia in acute stroke stage with three-year mortality in patients with first-ever ischemic stroke. Cerebrovasc Dis. 2012;34(1):55–62.

    Article  CAS  PubMed  Google Scholar 

  77. Rodrigues B, Staff I, Fortunato G, McCullough LD. Hyponatremia in the prognosis of acute ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23:850.

    Article  PubMed  Google Scholar 

  78. Mack WJ, Kellner CP, Sahlein DH, Ducruet AF, Kim GH, Mocco J, et al. Intraoperative magnesium infusion during carotid endarterectomy: a double-blind placebo-controlled trial. J Neurosurg. 2009;110(5):961–7.

    Article  PubMed Central  PubMed  Google Scholar 

  79. Longstreth Jr WT, Fahrenbruch CE, Olsufka M, Walsh TR, Copass MK, Cobb LA. Randomized clinical trial of magnesium, diazepam, or both after out-of-hospital cardiac arrest. Neurology. 2002;59(4):506–14.

    Article  CAS  PubMed  Google Scholar 

  80. Muir KW, Lees KR, Ford I, Davis S. Magnesium for acute stroke (Intravenous Magnesium Efficacy in Stroke trial): randomised controlled trial. Lancet. 2004;363(9407):439–45.

    Article  CAS  PubMed  Google Scholar 

  81. Saver JL, Starkman S, Eckstein M, Stratton S, Pratt F, Hamilton S, et al. Methodology of the Field Administration of Stroke Therapy - Magnesium (FAST-MAG) phase 3 trial: Part 1 - rationale and general methods. Int J Stroke. 2014;9(2):215–9.

    Article  PubMed  Google Scholar 

  82. Saver JL, Starkman S, Eckstein M, Stratton S, Pratt F, Hamilton S, et al. Methodology of the Field Administration of Stroke Therapy - Magnesium (FAST-MAG) phase 3 trial: Part 2 - prehospital study methods. Int J Stroke. 2014;9(2):220–5.

    Article  PubMed  Google Scholar 

  83. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–12.

    Article  PubMed Central  PubMed  Google Scholar 

  84. Khatri M, Himmelfarb J, Adams D, Becker K, Longstreth WT, Tirschwell DL. Acute kidney injury is associated with increased hospital mortality after stroke. J Stroke Cerebrovasc Dis. 2014;23:25.

    Article  PubMed  Google Scholar 

  85. Penko M, Fabjan TH, Bevc S, Kanic V, Hojs R. A prospective study about impact of renal dysfunction and morbidity and mortality on cardiovascular events after ischemic stroke. Cardiol J. 2014;21:163.

    Article  PubMed  Google Scholar 

  86. Tsagalis G, Akrivos T, Alevizaki M, Manios E, Theodorakis M, Laggouranis A, et al. Long-term prognosis of acute kidney injury after first acute stroke. Clin J Am Soc Nephrol. 2009;4(3):616–22.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  87. Moos SI, van Vemde DN, Stoker J, Bipat S. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: a meta-analysis. Eur J Radiol. 2013;82(9):e387–99.

    Article  PubMed  Google Scholar 

  88. Josephson SA, Dillon WP, Smith WS. Incidence of contrast nephropathy from cerebral CT angiography and CT perfusion imaging. Neurology. 2005;64(10):1805–6.

    Article  PubMed  Google Scholar 

  89. Dittrich R, Akdeniz S, Kloska SP, Fischer T, Ritter MA, Seidensticker P, et al. Low rate of contrast-induced Nephropathy after CT perfusion and CT angiography in acute stroke patients. J Neurol. 2007;254(11):1491–7.

    Article  CAS  PubMed  Google Scholar 

  90. Hopyan JJ, Gladstone DJ, Mallia G, Schiff J, Fox AJ, Symons SP, et al. Renal safety of CT angiography and perfusion imaging in the emergency evaluation of acute stroke. AJNR Am J Neuroradiol. 2008;29(10):1826–30.

    Article  CAS  PubMed  Google Scholar 

  91. Lee M, Saver JL, Chang KH, Liao HW, Chang SC, Ovbiagele B. Low glomerular filtration rate and risk of stroke: meta-analysis. BMJ. 2010;341:c4249.

    Article  PubMed Central  PubMed  Google Scholar 

  92. Sozio SM, Armstrong PA, Coresh J, Jaar BG, Fink NE, Plantinga LC, et al. Cerebrovascular disease incidence, characteristics, and outcomes in patients initiating dialysis: the choices for healthy outcomes in caring for ESRD (CHOICE) study. Am J Kidney Dis. 2009;54(3):468–77.

    Article  PubMed Central  PubMed  Google Scholar 

  93. Tariq N, Adil MM, Saeed F, Chaudhry SA, Qureshi AI. Outcomes of thrombolytic treatment for acute ischemic stroke in dialysis-dependent patients in the United States. J Stroke Cerebrovasc Dis. 2013;22:e354.

    Article  PubMed  Google Scholar 

  94. Davenport A. Practical guidance for dialyzing a hemodialysis patient following acute brain injury. Hemodial Int. 2008;12(3):307–12.

    Article  PubMed  Google Scholar 

  95. Slowik A, Turaj W, Pankiewicz J, Dziedzic T, Szermer P, Szczudlik A. Hypercortisolemia in acute stroke is related to the inflammatory response. J Neurol Sci. 2002;196(1-2):27–32.

    Article  CAS  PubMed  Google Scholar 

  96. Saini M, Saqqur M, Kamruzzaman A, Lees KR, Shuaib A. Effect of hyperthermia on prognosis after acute ischemic stroke. Stroke. 2009;40(9):3051–9.

    Article  PubMed  Google Scholar 

  97. Reith J, Jorgensen HS, Pedersen PM, Nakayama H, Raaschou HO, Jeppesen LL, et al. Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet. 1996;347(8999):422–5.

    Article  CAS  PubMed  Google Scholar 

  98. Karaszewski B, Thomas RG, Dennis MS, Wardlaw JM. Temporal profile of body temperature in acute ischemic stroke: relation to stroke severity and outcome. BMC Neurol. 2012;12:123.

    Article  PubMed Central  PubMed  Google Scholar 

  99. den Hertog HM, van der Worp HB, van Gemert HM, Algra A, Kappelle LJ, van Gijn J, et al. The Paracetamol (Acetaminophen) In Stroke (PAIS) trial: a multicentre, randomised, placebo-controlled, phase III trial. Lancet Neurol. 2009;8(5):434–40.

    Article  CAS  Google Scholar 

  100. Vermeij FH, Scholte op Reimer WJ, de Man P, van Oostenbrugge RJ, Franke CL, de Jong G, et al. Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke: data from the Netherlands Stroke Survey. Cerebrovasc Dis. 2009;27(5):465–71.

    Article  PubMed  Google Scholar 

  101. Ovbiagele B, Hills NK, Saver JL, Johnston SC. Frequency and determinants of pneumonia and urinary tract infection during stroke hospitalization. J Stroke Cerebrovasc Dis. 2006;15(5):209–13.

    Article  PubMed Central  PubMed  Google Scholar 

  102. Boehme AK, Kumar AD, Dorsey AM, Siegler JE, Aswani MS, Lyerly MJ, et al. Infections present on admission compared with hospital-acquired infections in acute ischemic stroke patients. J Stroke Cerebrovasc Dis. 2013;22:e582.

    Article  PubMed  Google Scholar 

  103. King C, Garcia Alvarez L, Holmes A, Moore L, Galletly T, Aylin P. Risk factors for healthcare-associated urinary tract infection and their applications in surveillance using hospital administrative data: a systematic review. J Hosp Infect. 2012;82(4):219–26.

    Article  CAS  PubMed  Google Scholar 

  104. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31(4):319–26.

    Article  PubMed  Google Scholar 

  105. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625–63.

    Article  PubMed  Google Scholar 

  106. Walker KA, Sampson JB, Skalabrin EJ, Majersik JJ. Clinical characteristics and thrombolytic outcomes of infective endocarditis-associated stroke. Neurohospitalist. 2012;2(3):87–91.

    Article  PubMed Central  PubMed  Google Scholar 

  107. Chang YL, Hung SH, Ling W, Lin HC, Li HC, Chung SD. Association between ischemic stroke and iron-deficiency anemia: a population-based study. PLoS One. 2013;8(12):e82952.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  108. Kellert L, Martin E, Sykora M, Bauer H, Gussmann P, Diedler J, et al. Cerebral oxygen transport failure?: decreasing hemoglobin and hematocrit levels after ischemic stroke predict poor outcome and mortality: STroke: RelevAnt Impact of hemoGlobin, Hematocrit and Transfusion (STRAIGHT) - an observational study. Stroke. 2011;42(10):2832–7.

    Article  CAS  PubMed  Google Scholar 

  109. Sico JJ, Concato J, Wells CK, Lo AC, Nadeau SE, Williams LS, et al. Anemia is associated with poor outcomes in patients with less severe ischemic stroke. J Stroke Cerebrovasc Dis. 2013;22(3):271–8.

    Article  PubMed  Google Scholar 

  110. Lelubre C, Vincent JL. Red blood cell transfusion in the critically ill patient. Ann Intens Care. 2011;1:43.

    Article  Google Scholar 

  111. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340(6):409–17.

    Article  CAS  PubMed  Google Scholar 

  112. Kirresh O, Kamara A, Samadian S. Hypoglycaemic haemiparesis. BMJ Case Rep. 2013;2013:pii: bcr2013008893.

    Article  Google Scholar 

  113. Yoshino T, Meguro S, Soeda Y, Itoh A, Kawai T, Itoh H. A case of hypoglycemic hemiparesis and literature review. Ups J Med Sci. 2012;117(3):347–51.

    Article  PubMed Central  PubMed  Google Scholar 

  114. Ma JH, Kim YJ, Yoo WJ, Ihn YK, Kim JY, Song HH, et al. MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging. Neuroradiology. 2009;51(10):641–9.

    Article  PubMed  Google Scholar 

  115. Ntaios G, Egli M, Faouzi M, Michel P. J-shaped association between serum glucose and functional outcome in acute ischemic stroke. Stroke. 2010;41(10):2366–70.

    Article  CAS  PubMed  Google Scholar 

  116. Gentile NT, Seftchick MW, Huynh T, Kruus LK, Gaughan J. Decreased mortality by normalizing blood glucose after acute ischemic stroke. Acad Emerg Med. 2006;13(2):174–80.

    Article  PubMed  Google Scholar 

  117. Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.

    Article  PubMed  Google Scholar 

  118. Bruno A, Durkalski VL, Hall CE, Juneja R, Barsan WG, Janis S, et al. The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial protocol: a randomized, blinded, efficacy trial of standard vs. intensive hyperglycemia management in acute stroke. Int J Stroke. 2014;9(2):246–51.

    Article  PubMed Central  PubMed  Google Scholar 

  119. Amin AN, Lin J, Thompson S, Wiederkehr D. Rate of deep-vein thrombosis and pulmonary embolism during the care continuum in patients with acute ischemic stroke in the United States. BMC Neurol. 2013;13:17.

    Article  PubMed Central  PubMed  Google Scholar 

  120. Dennis M, Sandercock P, Reid J, Graham C, Forbes J, Murray G. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet. 2013;382(9891):516–24.

    Article  CAS  PubMed  Google Scholar 

  121. Kamphuisen PW, Agnelli G. What is the optimal pharmacological prophylaxis for the prevention of deep-vein thrombosis and pulmonary embolism in patients with acute ischemic stroke? Thromb Res. 2007;119(3):265–74.

    Article  CAS  PubMed  Google Scholar 

  122. Sherman DG, Albers GW, Bladin C, Fieschi C, Gabbai AA, Kase CS, et al. The efficacy and safety of enoxaparin versus unfractionated heparin for the prevention of venous thromboembolism after acute ischaemic stroke (PREVAIL Study): an open-label randomised comparison. Lancet. 2007;369(9570):1347–55.

    Article  CAS  PubMed  Google Scholar 

  123. Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P. Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):630s–69.

    Article  CAS  PubMed  Google Scholar 

  124. California Acute Stroke Pilot Registry Investigators. The impact of standardized stroke orders on adherence to best practices. Neurology. 2005;65(3):3605.

    Google Scholar 

  125. Miano TA, Reichert MG, Houle TT, MacGregor DA, Kincaid EH, Bowton DL. Nosocomial pneumonia risk and stress ulcer prophylaxis: a comparison of pantoprazole vs ranitidine in cardiothoracic surgery patients. Chest. 2009;136(2):440–7.

    Article  PubMed  Google Scholar 

  126. Tsantes AE, Ikonomidis I, Papadakis I, Bonovas S, Gialeraki A, Kottaridi C, et al. Impact of the proton pump inhibitors and CYP2C19*2 polymorphism on platelet response to clopidogrel as assessed by four platelet function assays. Thromb Res. 2013;132(2):e105–11.

    Article  CAS  PubMed  Google Scholar 

  127. Hamidon BB, Raymond AA. The risk factors of gastrointestinal bleeding in acute ischaemic stroke. Med J Malaysia. 2006;61(3):288–91.

    CAS  PubMed  Google Scholar 

  128. Hsu HL, Lin YH, Huang YC, Weng HH, Lee M, Huang WY, et al. Gastrointestinal hemorrhage after acute ischemic stroke and its risk factors in Asians. Eur Neurol. 2009;62(4):212–8.

    Article  PubMed  Google Scholar 

  129. Morneau KM, Reaves AB, Martin JB, Oliphant CS. Analysis of gastrointestinal prophylaxis in patients receiving dual antiplatelet therapy with aspirin and clopidogrel. J Manag Care Pharm. 2014;20(2):187–93.

    PubMed  Google Scholar 

  130. Sving E, Idvall E, Hogberg H, Gunningberg L. Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study. Int J Nurs Stud. 2014;51:717.

    Article  PubMed  Google Scholar 

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Aysenne, A.M., Josephson, S.A. (2016). Supportive Care and Management of Inhospital Complications. In: Ovbiagele, B. (eds) Ischemic Stroke Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-319-17750-2_6

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