Ischemic stroke natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Complications

Duration	Complications
Early complications ( <7 days )	Cerebral edema and herniation (within 96 hr) Expansion of the infarct/recurrent infarction Hemorrhagic transformation of the infarcted area Seizure Aspiration pneumonitis Gastrointestinal ulcers and/or bleeding Deep vein thrombosis and pulmonary embolism Myocardial infarction
Late complications ( >7 days )	Recurrent stroke Seizure Aspiration pneumonitis Deep vein thrombosis and pulmonary embolism Decubitus ulcer Permanent cognitive or language dysfunction Reduced ability to function or care for self Reduced social interactions Side effects of medications Permanent loss of mobility Malnutrition Spasticity Depression

Prognosis

Prognosis of stroke depends on factors such as

• Age of the patient
• Location of infarct
• Size and volume of infarct
• Extent of neurological damage
• Time to seek medical help
• Comorbid conditions such as
• Intevention such as thrombolysis
• Quality of rehabilition care
• Complications

Bad prognostic factors

Infarct size and location

• Large size of infarct
• Severe neurological deficit
• Large volume of infarct (supratentorial infarcts)
• Infarct location and vascular supply

• Cervical internal carotid artery
• Anterior choroidal artery
• Insular branch of middle cerebral artery
• Basilar artery
• Large intracranial artery

Presence of clinical complications

• Cerebral edema
• Fever
• Hyperglycemia >200mg/dl

Presence of other co morbid conditions

• Anemia
• Myocardial infarction
• Diabetes mellitus
• Atrial fibrillation
• Malnutrition
• Renal dysfunction
• Heart failure
• Cancer
• Coronary artery disease

Other

• Advanced age
• Low socioeconomic status
• African American population