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Understanding the reemergence of deficits after stroke

A recent study characterized the risk factors and clinical outcome of deficits after stroke, termed post-stroke recrudescence.

Stroke is a neurological disease that occurs when a blood vessel in the brain is either blocked or ruptures. Because blood cannot reach the brain, brain cells begin to die, which can cause very severe symptoms.

Stroke is a leading cause of death and disability in the United States.

Deficits after a stroke, or post-stroke recrudescence (PSR)

Sometimes, deficits after a stroke that had previously resolved may reappear. This phenomenon, termed post-stroke recrudescence (PSR), has yet to be fully characterized and understood.

Because little is known, it can be hard for medical professionals to distinguish PSR from other neurologically similar events, such as acute stroke, transient ischemic attack, and seizures.

The study

Topcuoglu and colleagues aimed to describe post-stroke recrudescence imaging, risk factors, and clinical outcomes. They published their results in JAMA Neurology.

The study examined medical records from the Massachusetts General Hospital Research Patient Data Repository between January 1, 2000, and November 30, 2015. They identified 153 patients who met the preliminary diagnostic criteria for PSR.

Some of the criteria included worsening of deficits after stroke, imaging that showed chronic stroke, and no evidence of seizures. From the patient records, they examined clinical and imaging features, triggers, and risk factors of PSR by comparing those with and without PSR.

What was uncovered in the study?

The researchers found that the re-emergence of deficits after the stroke occurred on an average of 3.9 years after an initial stroke, lasted for 18.4 hours, and resolved within the first day in the majority of cases.

The deficits after stroke were typically short, mild, and affected motor, sensory, and language functions.

Compared to patients who did not experience reemergence of deficits after stroke, those with PSR were more often women and African American.

There were also more patients with diabetes and smoking in the post-stroke recrudescence group.

This report is one of the first to examine the re-emergence of deficits after stroke, and the authors hope that it will be the first of many. They stated, “We envision that our diagnostic criteria and the results of this first attempt to characterize PSR will stimulate larger validation studies and ultimately enable prompt diagnosis and distinction from mimics in medical centers across the world.”

Written by Liana Merrill, PhD

Reference: Topcuoglu, M.A. et al. (2017). Recrudescence of deficits after stroke. JAMA Neurology.

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