Stroke: subacute/inpatient management of acute ischemic stroke

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.