What is a recurrent stroke?
A recurrent stroke is defined as:
- a stroke with clinical evidence of the sudden onset of a new focal neurological deficit with no apparent cause other than that of vascular origin (i.e., the deficit could not be ascribed to a concurrent acute illness, epileptic seizure, or toxic effect) occurring at any time after the index (first) stroke, or
- clinical evidence of the sudden onset of an exacerbation ( increase) of a previous focal neurological deficit with no apparent cause other than that of vascular origin occurring 21 days after the index stroke.
A focal neurological deficit is a problem with nerve, spinal cord, or brain function. The problem can be usually traced to a specific brain area. It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue. Speech, vision, and hearing problems are also considered focal neurological deficits.
Vascular origin means that the problem originates from the vascular system of the affected. The vascular system is the body’s network of blood vessels. It includes arteries, which carry oxygen-rich blood from heart to tissues and organs, and veins which carry the blood and waste products back to your heart.
Per a 2020 study, about 23 % strokes are recurrent strokes i.e. the patient has already suffered one stroke and suffers another. Hence it is very important to know what are the risks leading to a recurrent stroke so as to minimize them.
What are it’s symptoms ?
The symptoms of recurrent stroke are same as that of first time stroke like, sudden severe headache, difficulty in walking, coordination, dizziness, and balance, weakness of the face, arms, or legs, particularly on one side of the body, trouble in speaking, confusion, memory, judgment or understanding, difficulty in swallowing food, trouble of vision from one or both eyes. Click here to know more about these symptoms.
What are the risk factors that may lead to a recurrent stroke ?
In order to minimize the recurrent stroke risk, we need to know what are the risk factors that can cause recurrent stroke. They are:
- Hyper- tension: A goal of <130/80 mm Hg is recommended to reduce risk of recurrent stroke. For patients with existing hypertension, individual drug regimens have to be designed considering, for example, comorbidities. For patients with no existing hypertension, anti-hypertenisve medication may be useful.
- Diabetes: As per AHA/ASA ( American Heart Association/ American Stroke Association) guidelines, screening should be done for all patients with a TIA ( Transient Ischemic Attack) or ischemic stroke for diabetes using a fasting plasma glucose measurement, or oral glucose tolerance test.
- Hyperlipidemia: Hyperlipidemia is an umbrella term that refers to any of several acquired or genetic disorders that result in a high level of lipids (fats, cholesterol and triglycerides) circulating in the blood. Studies indicate that lowering cholesterol to <70 mg/dL for LDL-C helps reduce risk of recurrent stroke in patients with no cardioembolic stroke. LDL-C or LDL Cholesterol is often called the “bad” cholesterol because it collects in the walls of your blood vessels, raising your chances of health problems like a heart attack or a stroke.
- Smoking: Cigarette smoking is an independent and strong risk factor for first ischemic stroke and silent cerebral infarction, approximately doubling the risk of stroke. Persistent cigarette smoking after stroke or TIA is associated with increased longer-term mortality rates, and evidence identifies a 2-fold risk of stroke recurrence in persistent smokers compared with nonsmokers. A silent cerebral infarction ( or asymptomatic cerebral infarction) is a stroke that does not have any usual outward symptoms associated with stroke. The patient is typically unaware they have suffered a stroke.
- Alcohol: Patients who take more than two alcoholic drinks a day ( for men ) and 1 a day ( for women ) should cut down on this to reduce risk of recurrent stroke. Binge drinking ( more than 4 drinks in one sitting) also increases the risk of recurrent stroke.
How to minimize the risk factors of recurrent stroke ?
The ways to minimize the risk of recurrent stroke are:
- Physical Activity: Regular physical activity improves stroke risk factors and may also reduce stroke risk itself. Moderate physical activity at least 3 to 5 times per week is most strongly associated with lower risk of recurrent stroke and vascular events.
- Controlling Blood pressure, obesity, diabetes, LDL-C etc. : If any of these is outside recommended ranges, steps must be taken to bring them under control.
- Stopping Smoking and Alcohol : These must be cut-off altogether, or reduced to the bare minimum.
- Antithrombotic Therapy: The AHA/ASA guidelines recommend the use of antiplatelet agents to reduce the risk of a recurrent event.
- Aspirin: Aspirin, 50 to 325 mg daily, is recommended for initial therapy to prevent recurrent ischemic stroke.
- Clopidogrel: Clopidogrel monotherapy, 75 mg daily, is recommended for secondary prevention of stroke and can also be used in patients who are allergic to aspirin.
- Warfarin: Vitamin K antagonists such as warfarin (Coumadin) are no better than other antiplatelet therapies with increased bleeding risk, and they are not recommended for prevention of recurrent ischemic stroke.
All drugs should be taken under strict medical supervision and only as prescribed by the treating doctor who knows fully the details of a specific case.