title: Stroke: subacute/inpatient management of acute ischemic stroke.
abstract: A stroke unit is a designated hospital area in which patients with stroke are evaluated and treated. Such units have been proven to reduce mortality and disability more than hospitalization in a general medical ward. Diagnostic testing for a patient with stroke includes complete blood count, urine toxicology screening, brain imaging, imaging of neck and cerebral arteries, and cardiac evaluation (including prolonged outpatient rhythm monitoring). Inpatient management should include dysphagia screening and prophylaxis for venous thromboembolism. Lower extremity compression stockings do not prevent venous thromboembolism in stroke patients, but intermittent pneumatic compression devices are of proven value. Patients who do not receive thrombolytic therapy should receive aspirin. A statin should be started if the patient's low-density lipoprotein cholesterol level is 100 mg/dL or higher. Delirium occurs commonly in patients with stroke and more commonly with increased age and stroke severity. Interventions, such as routine oxygen supplementation, prophylactic antibiotics, empiric antipyretic management, and early mobilization, are under investigation. Patients with arterial dissection and patent foramen ovale typically have good prognoses and can be treated medically.
authors.affiliation: Warren Alpert Medical School of Brown University, 110 Lockwood Street #324, Providence, RI 02903, brian_silver@brown.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
authors.affiliation: Sturdy Memorial Hospital, 211 Park St, Attleboro, MA 02703.
authors.forename: Rachel
authors.initials: R
authors.lastname: Wulf Silver
mesh_terms: D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications; D004396:Coloring Agents / Q000627:therapeutic use; D005260:Female; D006748:Hospital Departments / Q000379:methods; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007297:Inpatients; D015915:Motion Therapy, Continuous Passive / Q000379:methods; D010100:Oxygen / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D014552:Urinary Tract Infections / Q000150:complications / Q000517:prevention & control; D054556:Venous Thromboembolism / Q000150:complications / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D000959:Antihypertensive Agents; D004396:Coloring Agents; D010975:Platelet Aggregation Inhibitors; D010100:Oxygen