Medical complications of acute ischemic stroke are common and often lead to poor clinical outcomes. The frequency of medical complications must be recognized so that preventive strategies and appropriate treatment are employed.
The major medical complications associated with stroke will be reviewed here. Cardiac and pulmonary complications of stroke and poststroke seizures are discussed separately. (See "Cardiac complications of stroke" and "Stroke-related pulmonary complications and abnormal respiratory patterns" and "Overview of the management of epilepsy in adults", section on 'Post-stroke seizures'.)
The rates of reported medical complications of stroke are high (table 1) [1-4]. In a prospective study that analyzed the placebo group of the Randomized Trial of Tirilazad Mesylate in Acute Stroke (RANTTAS) database (n = 279), at least one medical complication occurred in 95 percent of patients, and at least one serious medical complication (defined as prolonged, immediately life threatening, or resulting in hospitalization or death) occurred in 24 percent . The most common serious medical complications were pneumonia (5 percent), gastrointestinal bleeding (3 percent), congestive heart failure (3 percent), and cardiac arrest (2 percent) (table 2).
Approximately 50 percent of deaths after stroke are attributed to medical complications. Prospectively collected data suggest that direct effects of ischemic stroke account for the majority of deaths within the first week after stroke, but medical complications predominately account for the mortality thereafter [2,5].
In support of these observations, an autopsy series found that the most common cause of death after ischemic and hemorrhagic stroke was cerebrovascular disease in the first week, pulmonary embolism in the second through fourth weeks, bronchopneumonia in the second and third months, and cardiac disease after three months . Furthermore, a single-center prospective study found that patients who experienced in-hospital medical complications after acute ischemic stroke had significantly higher mortality rates even four years after stroke onset . Older age, atrial fibrillation, and greater disability at discharge were associated with increased mortality after one year in survivors.