In the poststroke setting, patients should be screened for depression and, if appropriate, treated with antidepressants. Regular skin assessments are recommended with objective scales, and skin friction and pressure should be actively minimized with regular turning, good skin hygiene, and use of specialized mattresses, wheelchair cushions, and seating until mobility returns. Early rehabilitation for hospitalized stroke patients should be provided, but high-dose, very-early mobilization within 24 hours of stroke should not be done because it reduces the odds of a favorable outcome at 3 months.
Completing the diagnostic evaluation for the cause of stroke and decreasing the chance of future strokes should be part of the initial hospitalization. While MRI is more sensitive than is CT for detecting AIS, routine use of MRI in all patients with AIS is not cost effective and therefore is not recommended. For patients with nondisabling AIS in the carotid territory and who are candidates for carotid endarterectomy or stenting, noninvasive imaging of the cervical vessels should be performed within 24 hours of admission, with plans for carotid revascularization between 48 hours and 7 days if indicated. Cardiac monitoring for at least the first 24 hours of admission should be performed, while primarily looking for atrial fibrillation as a cause of stroke. In some patients, prolonged cardiac monitoring may be reasonable. With prolonged cardiac monitoring, atrial fibrillation is newly detected in nearly a quarter of patients with stroke or TIA, but the effect on outcomes is uncertain. Routine use of echocardiography is not recommended but may be done in selected patients. All patients should be screened for diabetes. It is not clear whether screening for thrombophilic states is useful.
All patients should be counseled on stroke, and provided education about it and how it will affect their lives. Following their acute medical stay, all patients will benefit from rehabilitation, with the benefits associated using a program tailored to their needs and outcome goals.
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