Stroke Rehabilitation Update: New Perspectives on Old Issues-Stroke Rehabilitation Update: New Perspectives on Old Issues

Video Transcription

Video Summary

In this video, Dr. Mike Lodell discusses updates on outcomes, seizure prophylaxis, and DVT prophylaxis after hemorrhagic stroke. Hemorrhagic stroke accounts for about 10-15% of all strokes and has different mortality rates, recovery patterns, and prognosis compared to ischemic strokes. The initial mortality after hemorrhagic stroke is high, but long-term prognosis is usually better compared to ischemic strokes. For seizure prophylaxis, it is important to note that cerebrovascular disease is the number one cause of seizures in people over 60 years old. Seizure incidence is higher in hemorrhagic strokes, and seizures may be associated with increased length of stay, mortality, time on the ventilator, and delayed rehabilitation therapy. However, recent studies have suggested that seizure prophylaxis does not work and may even worsen outcomes. In terms of DVT prophylaxis, about 5% of hemorrhagic stroke patients may experience a pulmonary embolism (PE) within the first month after the stroke. The incidence of DVT is higher in hemorrhagic strokes compared to ischemic strokes. The use of graduated compression stockings or TEDs is not effective in preventing DVT in these patients. Instead, early intermittent pneumatic compression should be initiated within 1-4 days after the stroke, followed by low molecular weight heparin if the patient is immobile. In conclusion, patients with hemorrhagic stroke should receive appropriate rehabilitation care based on their individual needs. Seizure prophylaxis is generally not recommended, while DVT prophylaxis should include early intermittent pneumatic compression and, if necessary, low molecular weight heparin.

Keywords

Dr. Mike Lodell

outcomes

seizure prophylaxis

DVT prophylaxis

hemorrhagic stroke

ischemic strokes

seizures

mortality

rehabilitation therapy

DVT