In-hospital stroke

Summary Between 6•5% and 15•0% of all strokes occur in patients already in hospital, many of whom are there for surgical procedures or cardiac disorders. This important group of patients could potentially be assessed more rapidly than others and could be candidates for interventional therapies. However, delays in recognition and assessment are common, possibly related to comorbidities and the complexities of hospital practice. Risk factors for in-hospital stroke include specific operations and procedures (eg, cardiac surgery), previous medical disorders (especially a history of stroke), and certain physiological characteristics (including fever and dehydration). The stroke subtype is embolic in a large proportion, and there are various possible precipitating mechanisms. Outcome can be poor, with high mortality. Interventional therapies, particularly thrombolysis, are possible options. In the postoperative setting, intraarterial thrombolysis is feasible and reasonably safe in carefully selected patients. Experimental agents and the manipulation of physiological variables are other treatment possibilities that could be applied early in this group of patients. Increasing the awareness by hospital physicians of such interventions may be an important factor that reduces delays in assessment of patients who have stokes while in hospital.