Precautions for Stroke Patients Using Mannitol

Written by Liu Yan Hao
Neurology
Updated on February 09, 2025
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Patients with stroke, if experiencing cerebral hemorrhage, extensive cerebral infarction, or cerebral embolism, can develop cerebral edema. In such cases, it is necessary to use mannitol for dehydration to reduce intracranial pressure. Therefore, it is crucial to strictly determine the appropriate indications. For patients with cerebral hemorrhage, cerebral embolism, or extensive cerebral infarction, the peak period of cerebral edema generally occurs between five to seven days, during which time mannitol should be used to lower intracranial pressure. If the acute phase has passed, then there is no need to use mannitol. For some patients, using mannitol weeks later not only lacks therapeutic effect, it might even worsen the condition. Additionally, when using mannitol, it is important to monitor the patient's renal function. In patients with renal insufficiency, the use of mannitol may exacerbate renal damage, so monitoring changes in renal function is essential. (Please use medication under the guidance of a doctor.)

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Written by Zhang Hui
Neurology
1min 4sec home-news-image

What does a stroke cause?

Stroke primarily causes neurological deficits such as limb paralysis in patients. This paralysis is typically hemiplegic, where one side of the body lacks strength, the affected limbs cannot walk, and the upper limbs cannot be lifted. Stroke can also cause numbness in the limbs. Patients may experience reduced pain and temperature sensation on one side of the body, unable to feel pain or temperature. Additionally, stroke can lead to headaches and symptoms such as nausea and vomiting, commonly seen in hemorrhagic strokes, such as cerebral hemorrhage. Furthermore, strokes in specific brain areas like the frontal lobe, temporal lobe, and hippocampus can cause cognitive impairments. Patients become slow to react, have significantly reduced learning and memory capabilities, and their ability to perform daily activities and work is noticeably affected. Strokes can also cause unclear speech, where patients have difficulties in expressing themselves verbally and may even be unable to understand conversations.

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Written by Zhang Hui
Neurology
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Can stroke paralysis be cured?

For a disease like stroke, if paralysis occurs, a small portion of patients can be completely cured without any sequelae. These patients generally are younger in age, receive timely treatment, and do not have a particularly large area of cerebral infarction. However, for the majority of patients, some degree of sequelae is likely to remain. After a stroke, it is crucial to go to the hospital as quickly as possible. If thrombolytic treatment can be administered during the intravenous thrombolysis time window, it can be very effective, and a few patients may even be completely cured. For most patients, further treatment with antiplatelet therapy and rehabilitation training is needed. Although symptoms can significantly improve, complete recovery is relatively difficult.

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Written by Tang Bo
Neurology
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Key Points in the Treatment of Different Recovery Stages of Stroke

Stroke includes ischemic stroke and hemorrhagic stroke, namely cerebral infarction and cerebral hemorrhage. Their treatments are generally opposite. If it is a cerebral infarction, thrombolytic therapy is needed within 4.5 hours of the acute phase. It is necessary to consider whether there are indications and contraindications, and whether the patient and family members agree to undergo thrombolytic therapy. Regardless of whether thrombolytic therapy is administered, it is essential to subsequently check the condition of the cranial vessels to determine if surgical treatment is needed. If surgery is not required, hospitalization for conservative treatment might be necessary. Typically, about 7 to 14 days after the acute phase, rehabilitation treatment may be needed once the patient's condition stabilizes. The duration of rehabilitation treatment usually depends on the patient's recovery progress. Afterwards, it is important to consider the patient's underlying diseases, such as hypertension, diabetes, and other risk factors, to perform secondary prevention, which involves medication and control of risk factors. In the case of cerebral hemorrhage, the treatment during the acute phase depends on the amount and location of the bleeding and whether there are indications for surgery to determine if surgical treatment is necessary. If conservative treatment is chosen, it also involves hospital treatment, followed by possible rehabilitation treatment once stabilized.

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Written by Tang Ying
Physical Medicine and Rehabilitation
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Treatment of urinary retention in stroke patients

In cases of urinary retention after a stroke, some patients experience this due to psychological factors, concerns, and the sudden need to remain in bed, making it difficult to urinate in bed since they cannot stand or squat. Therefore, the first step is to alleviate psychological factors, provide patient communication and counseling, and perform massages around the navel and abdomen, along with heat treatments, to help patients urinate on their own. In a second scenario, where the patient's condition is severe or even comatose, and they have difficulty urinating, a catheter can be placed. It's important to first try to rule out a urinary tract infection, collect a midstream urine sample for analysis, and ensure the catheter is not left in longer than necessary. Once the patient's condition improves or they regain consciousness, the catheter should be removed promptly to avoid any urinary tract infections.

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Physical Medicine and Rehabilitation
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What is the goal of rehabilitation during the acute phase of a stroke?

Rehabilitation goals during the acute phase of stroke. In the acute phase, we usually can intervene with rehabilitation treatment 48 hours after the patient’s vital signs have stabilized. The main goals of rehabilitation during the acute phase are to prevent complications such as pressure ulcers, atelectasis pneumonia, urinary tract infections, deep vein thrombosis, and muscle atrophy. Additionally, it aims to improve impaired neurological functions such as sensory, motor, and speech therapies, and to enhance the patient’s ability for self-care and mobility.