J Neurol Neurosurg Psychiatry 1998;64:771-776 ( June )

Mechanisms of second and further strokes

Haruko Yamamoto, Julien Bogousslavsky

Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Correspondence to: Professor Julien B Bogousslavsky, Service de Neurologie, Centre Hospitalier Universitaire Vaudois-BH13, CH-1011 Lausanne, Switzerland.

Received 17 July 1997 and in revised form 9 March 1998; Accepted 11 March 1998

OBJECTIVESThe mechanisms underlying recurrent stroke may be complex and multifactorial, but they have not been studied systematically. The aim was to analyse the different patterns and pathophysiological mechanisms of second and further strokes.
METHODSRecurrent stroke patterns and mechanisms were studied in 102 patients admitted with second or further strokes to the stroke centre in Lausanne University Hospital.
RESULTSThe patients with an initial cardioembolic stroke experienced recurrent stroke of the same type most often, followed by those with initial non-lacunar non-cardioembolic stroke, brain haemorrhage, and lacunar stroke (77%, 65%, 58%, and 48% respectively). Forty two per cent of the recurrent strokes in patients with an initial brain haemorrhage were ischaemic, whereas patients with ischaemic stroke only occasionally suffered brain haemorrhage (5%). In patients with brain haemorrhage, the lobar location predominated in both the first and all episodes (69% and 78% respectively), suggesting a small, occult arteriovenous malformation or cerebral amyloid angiopathy rather than hypertensive small artery disease. The functional disability of patients after an initial lacunar stroke was significantly better than in patients with other stroke subtypes (p<0.001), but the difference became non-significant after recurrent stroke (p=0.26).
CONCLUSIONSMost of the recurrent strokes were of the same type as the first episode for both cardioembolic and non-lacunar non-cardioembolic stroke, however, about half of the patients with an initial brain haemorrhage or a lacunar stroke experienced other types of stroke recurrently. The findings suggest that the coexistence of multiple aetiologies may play a major part in determining the mechanism of stroke recurrence. The study is an important step in understanding the patterns of stroke recurrence, which may be critical for better prevention.

Keywords: cerebral infarction; intracerebral haemorrhage; recurrence

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© 1998 by Journal of Neurology, Neurosurgery, and Psychiatry
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