Prevention of deep vein thrombosis is a standard component of care after stroke. The patient with an uninhibited bladder who has frequent episodes of urgency and incontinence may respond to treatment with oxybutynin. However, because this drug can worsen confusion, exacerbate heart disease, and cause diarrhea, close monitoring of patients who receive it is necessary. Seizures can occur at any time after a stroke as a result of the presence of scarred brain tissue, which serves as an irritable focus. Treatment with standard anticonvulsants is indicated.
Major depression occurs in at least one third of patients after stroke.
The guidelines for poststroke rehabilitation emphasize the need for screening for and treatment of this commonly overlooked complication. Treatment options include increased socialization, counseling, and medication. Medications with few side effects are preferred, especially those that produce less sedation and have few anticholinergic side effects. Selective serotonin reuptake inhibitors have favorable side effect profiles and have expanded the range of treatment options. Shoulder pain and dislocation are especially likely to occur in the patient with a flaccid upper extremity, because the joint capsule is normally stabilized by the surrounding muscles.