Complications of ischaemic stroke
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Complications of Ischaemic Stroke
Ischaemic stroke, a leading cause of death and disability worldwide, is associated with a range of complications that can significantly impact patient outcomes. These complications can be broadly categorized into neurological, cardiac, and systemic complications, each with distinct mechanisms and consequences.
Neurological Complications
Brain Oedema and Haemorrhagic Transformation
Neurological complications such as brain oedema and haemorrhagic transformation are common in the acute phase of ischaemic stroke. These complications can occur early and have serious short-term and long-term consequences. Brain oedema, the swelling of brain tissue, can lead to increased intracranial pressure and potentially fatal brain herniation . Haemorrhagic transformation, where the ischaemic area bleeds, can exacerbate brain injury and complicate recovery .
Recurrent Ischaemic Events
Patients with atrial fibrillation (AF) who suffer an ischaemic stroke are at a heightened risk of recurrent ischaemic events, such as stroke or transient ischemic attack (TIA), within the first 90 days. Factors such as prior stroke or TIA and significant arterial stenosis are predictors of these recurrent events. Early detection and management are crucial to prevent further neurological damage.
Cardiac Complications
Stroke-Heart Syndrome
Cardiac complications, collectively termed stroke-heart syndrome, are frequent in the days following an ischaemic stroke. This syndrome includes myocardial injury, cardiac dysfunction, and arrhythmias, which are believed to result from stroke-induced dysregulation of the central autonomic network. These cardiac disturbances can lead to myocardial necrosis, microvascular dysfunction, and arrhythmogenesis, significantly worsening the prognosis .
Long-Term Cardiovascular Risks
Patients with stroke-heart syndrome face a higher risk of long-term adverse cardiovascular events, including recurrent stroke, acute myocardial infarction (AMI), and increased mortality. These risks are particularly pronounced in younger patients and those with pre-existing conditions such as diabetes and high LDL cholesterol.
Systemic Complications
Infections
Infections are a significant systemic complication of ischaemic stroke. They can act as both a trigger for stroke and a subsequent complication, affecting up to a third of stroke patients. Post-stroke infections, such as pneumonia and sepsis, are associated with worsened outcomes and increased mortality . The immune response to stroke, including brain-induced immunodepression, plays a critical role in the susceptibility to infections.
Other Systemic Issues
Other systemic complications include respiratory failure, kidney and liver injury, and deep venous thrombosis. These complications can arise from the systemic inflammatory response triggered by the stroke and can lead to multi-organ failure if not promptly managed .
Conclusion
The complications of ischaemic stroke are diverse and can significantly impact patient outcomes. Early detection, prevention, and management of these complications are crucial to improving prognosis. Multidisciplinary approaches involving neurologists, cardiologists, intensivists, and other healthcare professionals are essential to address the complex needs of stroke patients and mitigate the risks of both neurological and systemic complications.
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