Complications after stroke

Abstract

Stroke is one of the leading causes of death and disability. If patients develop a complication in the first days after stroke, such as fever or a pneumonia, their recovery is often worse and the risk of death is higher. These complications are usually treated after they occur, but prevention may be a better approach. In this thesis, we show that in animal studies involving animals with a cerebral infarction, an elevated body temperature leads to a larger infarct volume and a poorer recovery. This supports the idea that preventing fever may be important. We also show that pneumonia typically develops within the first hours to days after a stroke. Moreover, we demonstrate that about 15% of patients already show signs of pneumonia on a chest CT scan upon hospital admission. Prevention should therefore be initiated early after a stroke. In the international PRECIOUS trial, conducted in 1,471 patients across 67 European hospitals, we investigated whether early administration of paracetamol, antibiotics, and antiemetic medication could reduce the occurrence of complications and improve recovery in older patients with stroke. The treatments proved safe but did not improve survival or recovery outcomes. Our research faced considerable bureaucratic obstacles in setting up and conducting the study, which made the results less certain than we had hoped. This highlights the urgent need to simplify the approval process and regulations surrounding scientific research.