Learning objectives
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Chest infections can be seen in as many as 20% post stroke. Pneumonia is a major cause of morbidity and mortality after stroke. Pneumonia after stroke is associated with older age, dysarthria/aphasia, severity of post-stroke disability, cognitive impairment, and an abnormal water swallow test. Severe stroke and increasing age were shown to be the main early predictors for infections after stroke. There is no clear definition of post-stroke pneumonia. Some divide them into acute and chronic forms, with 1-month post-stroke being the cut off-threshold. Chest infections may happen for various reasons. Chest infection can result from simply being bed bound with basal atelectasis and immobility. It is commoner in those with severe neurological impairment, the elderly and diabetes and those needing mechanical ventilation. Chest infection carries an almost 3-fold increase in risk of death. The diagnosis of stroke-associated pneumonia often requires symptoms of breathlessness and malaise, auscultatory findings though most older patients may have lung crackles, percussion findings, fever, secretions, raised CRP, microbiological (e.g. sputum cultures) and radiological signs
Chest Infections/Aspiration Pneumonia