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Topic 1093 Version 45.0 https://www.uptodate.com/contents/complications-of-stroke-an-overview/print 27/34 7/5/23, 12:05 PM Complications of stroke: An overview - UpToDate GRAPHICS Common medical complications of stroke Complication Percent Falls 25 Urinary tract infection 24 Chest infection 22 Pressure sores 21 Depression 16 Shoulder pain 9 Deep venous thrombosis 2 Pulmonary embolism 1 Medical complications of stroke were frequent in a prospective multicenter study of 311 patients followed weekly through hospital discharge and again at 6, 18, and 30 months after stroke. Data from: Langhorne, P, Stott, DJ, Robertson, L, et al. Medical complications after stroke: a multicenter study. Stroke 2000; 31:1223. Graphic 52076 Version 2.0 https://www.uptodate.com/contents/complications-of-stroke-an-overview/print 28/34 7/5/23, 12:05 PM Complications of stroke: An overview - UpToDate Serious medical complications of stroke Complication Percent All pneumonias 5 Aspiration pneumonia alone 3 Heart failure 3 Gastrointestinal bleeding 3 Cardiac arrest 2 Angina/MI/cardiac ischemia 1 Deep venous thrombosis 1 Pulmonary embolism 1 Hypoxia 1 Urinary tract infection 1 Sepsis 1 Cellulitis 1 Peripheral vascular disorder 1 Dyspnea 1 Pulmonary edema 1 Dehydration 1 In a prospective study that analyzed the placebo group of the RANTTAS database (n = 279), at least one serious medical complication (defined as prolonged, immediately life threatening, or resulting in hospitalization or death) occurred in 24 percent of patients. Data from: Johnston, KC, Li, JY, Lyden, PD, et al. Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. RANTTAS Investigators. Stroke 1998; 29:447. Graphic 68148 Version 3.0 https://www.uptodate.com/contents/complications-of-stroke-an-overview/print 29/34 7/5/23, 12:05 PM Complications of stroke: An overview - UpToDate Causes of elevated troponin Myocardial ischemia Acute coronary syndrome STEMI NSTEMI Other coronary ischemia Arrhythmia: tachy- or brady- Cocaine/methamphetamine use Coronary intervention (PCI or cardiothoracic surgery) Coronary artery spasm (variant angina) Stable coronary atherosclerotic disease in setting of increased O demand (eg, tachycardia) 2 Severe hypertension Coronary embolus Aortic dissection Coronary artery vasculitis (SLE, Kawasaki) Noncoronary ischemia Shock (hypotension) Hypoxia Hypoperfusion Pulmonary embolism Global ischemia Cardiothoracic surgery Myocardial injury with no ischemia Comorbidities Renal failure Sepsis Infiltrative diseases Acute respiratory failure Stroke Subarachnoid hemorrhage https://www.uptodate.com/contents/complications-of-stroke-an-overview/print 30/34 7/5/23, 12:05 PM Complications of stroke: An overview - UpToDate Specific identifiable precipitants Extreme exertion Cardiac contusion Burns >30% BSA Cardiotoxic meds: anthracyclines, herceptin Electrical shock Carbon monoxide exposure Other Stress (takotsubo) cardiomyopathy Myocarditis Myopericarditis Rhabdomyolysis involving cardiac muscle Hypertrophic cardiomyopathy Peripartum cardiomyopathy Heart failure, malignancy, stress cardiomyopathy STEMI: ST elevation myocardial infarction; NSTEMI: non-ST elevation myocardial infarction; PCI: percutaneous coronary intervention; SLE: systemic lupus erythematosus; BSA: body surface area. Graphic 54910 Version 15.0 https://www.uptodate.com/contents/complications-of-stroke-an-overview/print 31/34 7/5/23, 12:05 PM Complications of stroke: An overview - UpToDate Causes of neurogenic pulmonary edema Major causes Epileptic seizures, particularly status epilepticus Intracranial hemorrhage (including intracerebral hemorrhage, intraventricular hemorrhage, epidural hemorrhage, subdural hemorrhage) Head injury Minor causes Guillain-Barr syndrome Multiple sclerosis with medullary involvement Nonhemorrhagic strokes Trigeminal nerve block Bulbar poliomyelitis Vertebral artery ligation Vertebral artery dissection Ruptured spinal arteriovenous malformation Air embolism Brain tumors Electroconvulsive therapy Induction of general anesthesia Colloid cyst Hydrocephalus Reye syndrome Bacterial meningitis Viral meningoencephalitis (including enterovirus-7) Cervical spinal cord injury Cryptococcal meningoencephalitis Hyponatremia High-voltage electrical injury Graphic 57483 Version 6.0 https://www.uptodate.com/contents/complications-of-stroke-an-overview/print 32/34 7/5/23, 12:05 PM Complications of stroke: An overview - UpToDate Respiratory patterns associated with neurological injury Graphic 74371 Version 2.0 https://www.uptodate.com/contents/complications-of-stroke-an-overview/print 33/34 7/5/23, 12:05 PM Complications of stroke: An overview - UpToDate Contributor Disclosures Koto Ishida, MD No relevant financial relationship(s) with ineligible companies to disclose. Scott E Kasner, MD Grant/Research/Clinical Trial Support: Bayer [Stroke]; Bristol Meyers Squibb [Stroke]; Medtronic [Stroke]; WL Gore and Associates [Stroke]. Consultant/Advisory Boards: Abbvie [Stroke]; AstraZeneca [Stroke]; BMS [Stroke]; Diamedica [Stroke]; Medtronic [Stroke]. All of the relevant financial relationships listed have been mitigated. John F Dashe, MD, PhD No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/complications-of-stroke-an-overview/print 34/34