Short-term prognosis after major stroke

Short-term prognosis after major stroke 

The short term prognosis after major stroke depends on stroke subtype (Table 16.1), the occurrence of stroke-associated complications, stroke extension or recurrence. Whilst stroke subtype is fixed, optimal acute stroke treatment can impact on stroke morbidity and mortaUty through minimizing the UkeUhood of neurological deterioration and the occurrence of compUcations such as pulmonary embolus and pneumonia (Ch. 20) as well as through the administration of specific therapies (Ch. 21). 

The prognosis of hospitalized patients tends to be worse than that of patients in the population at large because mild strokes are more likely to be cared for at home. In the community, about 20% of all patients with first-ever stroke are dead within a month. Deaths in the first few days are almost all caused by the brain lesion itself Deaths after the first week are more likely to be indirect consequences of the brain lesion, such as bronchopneumonia, pulmonary embolism, coincidental cardiac disease or recurrence. 

The prognosis is much better for ischemic stroke overall than for intracranial hemorrhage, with approximately 10% and 50% dying, respectively (Bamford et al. 1990 Lovelock et al. 2007). Early characteristics predicting death in patients with primary intracerebral hemorrhage are  

So far predictive models only apply to a small proportion of patients and are not sufficiently accurate to inform treatment decisions in routine clinical practice. The various subtypes of ischemic stroke have very different outcomes patients with total anterior circulation infarction (TACI) have just as poor an outcome as those with primary intracerebral hemorrhage (Table 16.1). The best single predictor of early death is impaired consciousness, but many other predictors of survival have been identified (Table 16.2). Many of these variables are inter-related, but prognostic models based on independent variables do not provide much more information than an experienced clinician s estimate (Counsell and Dennis 2001 Counsell et al. 2002). 

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Short-term prognosis after major stroke... 

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