Examqo › Examqo library › Physical medicine and rehabilitation › Stroke and cognition
Medical complications after stroke
After stroke, complications such as shoulder pain, depression, aspiration, venous thrombosis and falls hold back rehabilitation as much as the weakness itself — so they are looked for systematically and prevented from day one.
Why it matters in the exam
The exam asks about causes and treatment of hemiplegic shoulder pain, prevention of venous thrombosis, swallow screening, depression, seizures and central pain. Hemiplegic shoulder pain is very common; causes include subluxation in the flaccid stage, spasticity, frozen shoulder, tendon injury and CRPS. Prevention includes correct positioning and support of the arm, avoiding pulling on the arm and avoiding overhead pulley exercises; treatment includes botulinum injections into spastic muscles, a suprascapular nerve block and electrical stimulation of the shoulder muscles for subluxation.
Venous thrombosis: in a patient who is not walking, intermittent pneumatic compression of the legs (the CLOTS 3 trial) reduced thrombosis, and compression stockings alone are not recommended; prophylactic heparin is given according to bleeding risk. Swallowing: a screening test before any food or drugs by mouth, and with suspected aspiration — clinical assessment and an instrumental study. Post-stroke depression occurs in about a third of patients, holds back rehabilitation and is treated with talking therapy and drugs (usually an SSRI). Seizures can occur, but anti-seizure drugs are not given prophylactically.
Central post-stroke pain (Dejerine-Roussy syndrome) usually follows a thalamic lesion: burning pain on the affected side with hypersensitivity to touch and cold, treated with drugs for neuropathic pain (amitriptyline, lamotrigine, pregabalin). Other complications: urinary incontinence (usually an uninhibited bladder), falls and fractures on the paretic side (disuse osteoporosis), pressure injuries, fatigue, spasticity and return to driving — which needs assessment of vision, attention and judgement.
Key points
- Hemiplegic shoulder pain is common; prevent with positioning and support.
- Intermittent pneumatic compression to prevent thrombosis.
- Swallow screen before food by mouth.
- Depression in about a third of patients.
- Central pain after a thalamic lesion.
Summary table
| Complication | Clues | Prevention and treatment |
|---|---|---|
| Hemiplegic shoulder pain | Pain on movement, subluxation, spasticity | Positioning and support; no overhead pulley; botulinum, suprascapular nerve block |
| Venous thrombosis | Patient not walking | Intermittent pneumatic compression; heparin by risk |
| Aspiration and pneumonia | Coughing when eating, "wet" voice | Swallow screen before food by mouth |
| Depression | Low motivation, tearfulness, poor engagement | Routine screening, talking therapy and an SSRI |
| Central (thalamic) pain | Burning pain and hypersensitivity on the affected side | Amitriptyline, lamotrigine, pregabalin |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Physical medicine and rehabilitation.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery, 2016 — Prevention and treatment of medical complications
- CLOTS 3 trial: Intermittent pneumatic compression after stroke, 2013 — DVT prevention in immobile patients
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.