Poststroke Deficit Recrudescence: Signs and Symptoms to Look For

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Patients with a history of smoking or diabetes are at increased risk for poststroke recrudescence.
Patients with a history of smoking or diabetes are at increased risk for poststroke recrudescence.

Fever, infection, a history of smoking and diabetes, and African-American race are among the triggers and risk factors associated with poststroke recrudescence (PSR), according to a study published in JAMA Neurology.

Investigators retrospectively analyzed data from a crossover cohort and case-control study to identify triggers and risk factors for PSR. Patient information was extracted from the Massachusetts General Hospital Research Patient Data Repository, with the final analysis including 153 patients with a primary or secondary diagnosis of cerebrovascular disease who met the PSR diagnostic criteria. A control group in the crossover cohort study included patients with discrete hospitalizations without recrudescence occurrence.

Compared with patients without recrudescence, patients with PSR were more likely to be female (62.1%) or African American (17.2%). In addition, patients with PSR had higher rates of dyslipidemia and diabetes (58.6% and 42.1%, respectively), were more likely to smoke (22.8%), and had more infarcts from small-vessel disease (15.9%). Identified triggers for PSR included hypotension, infection, hyponatremia, and benzodiazepine use.

PSR was also found to occur more frequently in patients with ischemic stroke compared with hemorrhagic stroke, with symptoms occurring approximately 4 years after the index stroke. The average duration of PSR was 18.4 hours. Motor-sensory function was generally affected by mild and abrupt deficits. The middle cerebral artery territory was involved in the underlying chronic strokes of 112 patients (73%).

The retrospective nature of the study, as well as the small patient population, represent the main limitations of this study. In addition, the search term restriction to recrudescence alone may have limited the number of potential cases the investigators could evaluate.

The investigators concluded that the observed results "ultimately enable prompt diagnosis and distinction from mimics in medical centers across the world" and emphasized the need for future prospective research to evaluate and verify the study's suggested diagnostic criteria.

Reference

Topcuoglu MA, Saka E, Silverman SB, Schwamm LH, Singhal AB. Recrudescence of deficits after stroke: clinical and imaging phenotype, triggers, and risk factors [published online August 7, 2017]. JAMA Neurol. doi: 10.1001/jamaneurol.2017.1668

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