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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What are the symptoms of a stroke?

Symptoms of stroke vary greatly, and it is crucial to judge based on the circumstances. The symptoms are mainly divided into two major categories: hemorrhagic stroke and ischemic stroke. The most common symptoms of hemorrhagic stroke are severe headaches, projectile vomiting, and the gradual onset of consciousness disorders. Some people might also experience limb numbness, weakness, speech impediments, and other conditions. The most common symptoms of ischemic stroke include dizziness, limb numbness, and speech impediments; sometimes, these symptoms alternate, so it is essential to pay attention to clinical observations and focus on differential diagnosis. There are also other types of symptoms, such as cognitive decline, urinary and fecal incontinence, unstable gait, swallowing difficulties, and coughing while swallowing. Therefore, it is imperative to visit a hospital in a timely manner for testing to clearly understand the specific changes in the patient's condition at that time, thus better facilitating the patient’s recovery.

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The difference between stroke and cerebral infarction

The difference between stroke and cerebral infarction lies in the scope of stroke, which is broader and includes cerebral infarction. Stroke is divided into hemorrhagic stroke and ischemic stroke. Common types of hemorrhagic stroke include cerebral hemorrhage and subarachnoid hemorrhage. Common types of ischemic stroke include cerebral infarction and cerebral thrombosis. Thus, the scope of stroke is relatively large and includes cerebral infarction. Cerebral infarction occurs when a blockage in the cerebral blood vessels leads to ischemia, edema, and necrosis of the brain tissue in the supplied area, resulting in symptoms of stroke. Additionally, cerebral embolism occurs when an embolus from another part of the body detaches and blocks a brain artery, causing ischemia and necrosis of the brain tissue in the supplied area, also leading to stroke.

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Post-stroke depression

Recent studies have confirmed that in addition to language dysfunction, cognitive impairment, and motor dysfunction, stroke patients also exhibit many signs of depression. According to guidelines published in China in 2016, about 33% of stroke patients experience post-stroke depression, which is a very high proportion. The main symptoms of post-stroke depression include a lack of interest in anything, unwillingness to communicate with others, being quiet and reticent, non-compliance with medication, and non-cooperation with rehabilitation training. Post-stroke depression significantly affects the recovery of patients and their future quality of life. Some patients may even turn to suicide due to depression. Therefore, it is crucial to pay attention to depression after a stroke, as the incidence rate of post-stroke depression is very high, reaching up to 33%. Clinicians must carefully identify it, and family members of patients must be attentive in their care.

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Rehabilitation nursing for stroke patients

For the rehabilitation and nursing care of stroke patients, first and foremost, we need to monitor the patient's vital signs, food intake, sleep, as well as bowel and bladder function. Secondly, we should pay attention to their psychological state, checking for signs of tension, anxiety, and depressive emotional reactions. Thirdly, we encourage patients to overcome their illness and to establish confidence in their recovery. Fourthly, we guide patients to actively engage in physical function exercises, as well as daily activities such as eating and dressing to practice their daily living skills. Fifthly, we manage proper limb positioning and patient turning, prevent pressure sores, and also prevent a series of complications such as venous thrombosis and urinary tract infections.

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The soft paralysis phase of a stroke refers to a few weeks after the onset.

The recovery of stroke patients is generally divided into four phases: the flaccid phase, also known as the hypotonic phase, the spastic phase, the recovery phase, and the sequelae phase. The symptoms of the flaccid phase mainly include muscle relaxation, low muscle tone, and lack of autonomous movement. The majority of patients maintain the flaccid phase for about one to three weeks, and depending on the individual's condition, they generally begin to enter the spastic phase after one to three weeks. A small portion of patients with severe conditions and poor initiative, who have not undergone formal rehabilitation training, may extend their flaccid phase to more than a month or even longer. Therefore, receiving early formal rehabilitation training to improve muscle strength and spasticity treatment can allow patients to smoothly transition through the flaccid phase and gradually enter the spastic phase. Good management of spasticity is even more beneficial for the patient’s recovery. Rehabilitation training can help stroke patients recover sooner and faster.