Medical Features

What Happens If I have Another Stroke?

Post on 06/11/16

The second can be more devastating than the first. Dr Tu Tian Ming gives an overview of what you need to know about preventing, and responding to another stroke.


Having a stroke is a life-changing event. Just ask any stroke survivor. No one can even start to comprehend the impact of losing one’s ability to perform simple day-to-day tasks that we all have taken for granted all our lives. This is not including the long and arduous journey of rehabilitation a stroke survivor has to go through and the blood, sweat and tears sacrificed by the immediate care-givers.

Now imagine having a second stroke.

A stroke occurs when one of the blood vessels that supply the brain is blocked by a blood clot, impairing blood supply to the brain. The brain is subsequently deprived of oxygen and glucose, resulting in death of brain tissue.

Having a second stroke increases the risk of death by 2 times1, causes longer duration of hospitalization and increased neurologic disability2. This unfortunate reality for recurrent stroke sufferers emphasizes the importance of prevention after the first stroke.

If a patient survives the first stroke, the probability of getting another stroke in the next 5 years is approximately 30%3. In fact, up a third of all recurrent strokes occur within the first 90 days after the initial first stroke2. This makes the first 90 days post-stroke a critical window period for intensive treatment and lifestyle changes to occur for a stroke survivor4.

The risk of having a second stroke after the first stroke depends on many factors, some we can change and some we cannot. Risk factors we cannot change include male gender, presence of atrial fibrillation and severity of initial stroke1. Fortunately, there are many things we can do to reduce the risk of a second stroke. These include reducing high blood pressure, weight reduction, increase in physical activity and taking medications for stroke prevention, such as aspirin4, 5.

The key to a good outcome in a second stroke is early recognition of symptoms, rapid access to hospital care and early treatment. F.A.S.T. is an easy way to remember the sudden signs of stroke: Face droop, Arm weakness, Speech difficulty, Time to call the ambulance.

Treatment of the second stroke is similar to treatment for patients with the first stroke. The first line of treatment is still a clot-busting medication called the recombinant tissue plasminogen activator (rTPA). rTPA is given via the vein in the hospital setting after a scan has excluded bleeding in the brain. However, rTPA can only be given within 4.5 hours of onset of symptoms. A new treatment option of endovascular thrombectomy, which is the pulling out of the blood clot from the brain with a flexible wire inserted through the groin, is given in addition to rTPA. This new treatment will extend the therapeutic time window up to 6 hours for a specific subtype of stroke6. The use of this alternative form of treatment requires detailed assessment by a trained stroke neurologist. Hence, rapid and timely access to the hospital is extremely critical.

In summary, having a second stroke is much more life threatening and debilitating than having the first stroke. Nevertheless, rapid recognition and treatment can allow for great potential for recovery. The key for all stroke patients is prevention and this begins with risk factor control and life-style changes.

Dr Tu Tian Ming is a neurologist with the National Neuroscience Institute, with subspecialties in stroke and neurointensive care.

 

References

  1. Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Stroke recurrence: Predictors, severity, and prognosis. The copenhagen stroke study. Neurology. 1997;48:891-895
  2. Ay H, Gungor L, Arsava EM, Rosand J, Vangel M, Benner T, et al. A score to predict early risk of recurrence after ischemic stroke. Neurology. 2010;74:128-135
  3. Hillen T, Coshall C, Tilling K, Rudd AG, McGovern R, Wolfe CD, et al. Cause of stroke recurrence is multifactorial: Patterns, risk factors, and outcomes of stroke recurrence in the south london stroke register. Stroke; a journal of cerebral circulation. 2003;34:1457-1463
  4. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke; a journal of cerebral circulation. 2014;45:2160-2236
  5. Rothwell PM, Algra A, Chen Z, Diener HC, Norrving B, Mehta Z. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: Time-course analysis of randomised trials. Lancet. 2016;388:365-375
  6. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 american heart association/american stroke association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke; a journal of cerebral circulation. 2015;46:3020-3035

 

 

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