BLOG: Concussion, TBI increase risk for stroke

ByGrace Turner, BSc, MSc, PhD

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A recent meta-analysis conducted by my colleagues and me at the University of Birmingham, England, shows that the risk for stroke is 86% higher in those who have suffered a traumatic brain injury, compared with people who have not had a TBI.

The risk for stroke is highest in the first 4 months immediately following the TBI but remains elevated even years later. Most importantly, stroke risk increases regardless of the severity of the injury, so even those who suffer a mild TBI, or concussion, are at risk.

A stroke is the loss of blood flow to the brain. About 80% of strokes are the ischemic type, in which a blood vessel in the brain becomes blocked or restricted. The remainder are hemorrhagic strokes, in which a blood vessel bursts, causing bleeding in the brain.

We looked only at studies of adults. Stroke is quite unusual in children and it is not known whether there is an increased risk among children who suffer a TBI or whether childhood TBI increases the risk for stroke later in life. Also notable is that people who were taking blood thinners or statins were less likely to have a stroke.

We don’t really know why a TBI would increase stroke risk, but there are at least three hypotheses.

Grace Turner

First, TBI may cause impairments in the cerebral vascular system that damage blood vessels, increase the chance of a blood clot or raise blood pressure. Second, lifestyle effects of a TBI could be implicated. For example, physical disability or mental health problems after a TBI may contribute to a more sedentary lifestyle, weight gain and increased smoking or alcohol consumption, which are all known risk factors for stroke. The third possibility is that antidepressants prescribed after TBI to treat depression and anxiety or to modulate mood-related behaviors are implicated. And, of course, all three of these factors (or other unknown factors) could be causing strokes.

Clearly, more research is needed to fully understand the relationship between TBI and stroke. It would also be helpful to have more information on whether the risks are greater for everyone who suffers a TBI or primarily for people with certain demographic characteristics or comorbidities.

However, based on our research there are three steps that can be taken right now.

Increase awareness of TBI-stroke link

Many people aren’t even aware that concussion is a brain injury, and common impacts from mild TBI — such as anxiety, depression, fatigue and vision symptoms — are already underrecognized.

Given the increased stroke risk, it is important for clinicians to proactively address known risk factors for stroke (smoking, obesity, diet and alcohol intake) where possible. It may be difficult for TBI patients with fatigue or mental health problems to make lifestyle changes, so these may need to be actively supported.

Don’t stop stroke prevention medications

It is not uncommon for patients to stop taking medications in the wake of a serious injury, either on medical advice or simply due to activity and cognitive changes that affect their compliance with a medication schedule.

However, because we know that medications such as statins and blood thinners were effective in preventing strokes in our study, patients already on these medications should be supported in continuing them following a TBI.

Educate TBI patients about stroke signs

Many people are aware of the FAST campaign (facial drooping, arm weakness, speech difficulties, time), which encourages people to recognize symptoms and get help quickly. Subtle visual symptoms (blur, double vision, peripheral vision loss, perceptual distortions, etc.) and loss of balance/coordination are also common but underrecognized stroke symptoms. It is important that patients and their caregivers be alert to any of these symptoms after a concussion or more serious TBI and seek emergency care.

When it comes to stroke, time is brain.

Reference:

• Turner GM, et al. Int J Stroke. 2021;doi:10.1177/17474930211004277.

For more information:

Grace Turner, BSc, MSc, PhD, is a postdoctoral research fellow at the Institute of Applied Health Research at the University of Birmingham in Birmingham, U.K. The research was funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre. Her primary research interests are focused on the long-term impact of transient ischemic attack, optimizing stroke prevention and patient-reported outcomes in primary care. She is also interested in the use of primary care medical records to conduct epidemiological research.

Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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