Treatment
ÎÎTreat concomitant medical diseases (I-C).
ÎÎInstitute early interventions to prevent recurrent stroke (I-C).
ÎÎThe use of aspirin is reasonable for treatment of patients who cannot
receive anticoagulants for prophylaxis of deep vein thrombosis (IIa-A).
ÎÎIn selecting between nasogastric and percutaneous endoscopic
gastrostomy tube routes of feeding in patients who cannot take solid
food or liquids orally, it is reasonable to prefer nasogastric tube
feeding until 2-3 weeks after stroke onset (IIa-B).
ÎÎThe use of intermittent external compression devices is reasonable for
treatment of patients who cannot receive anticoagulants (IIa-B).
ÎÎRoutine use of nutritional supplements has NOT been shown to be
beneficial (III-B).
ÎÎRoutine use of prophylactic antibiotics has NOT been shown to be
beneficial (III-B).
ÎÎRoutine placement of indwelling bladder catheters is NOT
recommended because of the associated risk of catheter-associated
urinary tract infections (III-C).
Treatment of Acute Neurological Complications
ÎÎPatients with major infarctions are at high risk for complicating
brain edema and increased intracranial pressure. Take measures to
lessen the risk of edema and closely monitor patients for signs of
neurological worsening during the first days after stroke (I-A).
Note: Consider early transfer of patients at risk for malignant brain edema to an
institution with neurosurgical expertise.
ÎÎDecompressive surgical evacuation of a space-occupying cerebellar
infarction is effective in preventing and treating herniation and brain
stem compression (I-B).
ÎÎDecompressive surgery for malignant edema of the cerebral
hemisphere is effective and potentially lifesaving (I-B).
Note: Advanced patient age and patient/family valuations of achievable outcome
states may affect decisions regarding surgery.
ÎÎRecurrent seizures after stroke should be treated in a manner similar
to other acute neurological conditions. Antiepileptic agents should be
selected by specific patient characteristics (I-B).
ÎÎPlacement of a ventricular drain is useful in patients with acute
hydrocephalus secondary to ischemic stroke (I-C).
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