Association Between Traumatic Brain Injury and Increased Risk of Stroke: A Systematic Review and Meta-analysis

Abstract

Objective: To determine whether exposure to traumatic brain injury (TBI) is associated with increased risk of stroke in adults compared with referents not exposed to TBI, and to understand whether an association exists throughout the spectrum of injury severity, whether it differs between the acute and chronic phases after TBI, and whether the association is greater with hemorrhagic compared with ischemic stroke after TBI. Setting: A database search was conducted on January 22, 2021. Searches were run in MEDLINE (1946 to present), Embase (1988 to present), Evidence-Based Medicine Reviews (various dates), Scopus (1970 to present), and Web of Science (1975 to present). Design: Observational studies that quantified the association of stroke after TBI compared with referents without TBI were included. Three coauthors independently reviewed titles and abstracts to determine study eligibility. Study characteristics were extracted independently by 2 coauthors who followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and study quality was assessed independently by 2 coauthors who used the Newcastle-Ottawa Scale. Random-effects meta-analyses were performed. Main Measures: The primary exposure was TBI of any severity, and the primary outcome was stroke of any kind. Subgroup analysis was performed to assess heterogeneity associated with severity of TBI, type of stroke, and time from TBI to stroke. Results: A total of 64 fulltext articles were reviewed, and data were extracted from 8 cohort studies (N = 619 992 individuals exposed to TBI along with nonexposed referents). A significant overall association was found with TBI and stroke (hazard ratio, 2.06; 95% CI, 1.28-3.32). Significant subgroup differences were found with a smaller risk of ischemic stroke compared with stroke of all types (P < .001, I 2 = 93.9%). Conclusions: TBI, regardless of injury severity, was associated with a higher risk of stroke. To improve secondary stroke prevention strategies, future studies should classify TBI severity and type of stroke more precisely and determine long-term risk.

Prevalence and characteristics of comorbid stroke and traumatic brain injury in a real-world population: findings from a nationally representative cross-sectional survey in China

“…On the one hand, previous TBI increased the risk of stroke and its major subtypes in the population in this study (see Supplementary Table 1 ). Similar to our findings in this study, previous case-control or cohort studies from hospital or insurance data also confirmed that previous TBI, even a concussion, increased the odds ratio or incidence of stroke and its subtype [ 6 , 7 , 9 , 12 – 17 ] and was more closely related to haemorrhagic stroke, including intracerebral haemorrhage and subarachnoid haemorrhage. [ 6 , 7 , 9 , 16 , 17 ] On the other hand, previous stroke also increased the risk of nonconcussion TBI in the population in this survey (see Supplementary Table 2 ).…”

“…Similar to our findings in this study, previous case-control or cohort studies from hospital or insurance data also confirmed that previous TBI, even a concussion, increased the odds ratio or incidence of stroke and its subtype [ 6 , 7 , 9 , 12 – 17 ] and was more closely related to haemorrhagic stroke, including intracerebral haemorrhage and subarachnoid haemorrhage. [ 6 , 7 , 9 , 16 , 17 ] On the other hand, previous stroke also increased the risk of nonconcussion TBI in the population in this survey (see Supplementary Table 2 ). Regrettably, despite the higher estimated incidence rates of falls and fall-related injuries of 88.0 and 2.8 per 100 person-years in stroke patients, respectively [ 18 ], there is little evidence that stroke increases the risk of TBI.…”

“…[ 4 ] The increasing prevalence of stroke and TBI in the population in recent years has greatly increased the probability and harm of the comorbidity of the two diseases. TBI is an independent risk factor for stroke, regardless of TBI severity or type, which has been further confirmed by previous meta-analyses [ 6 , 7 ]. To date, only one study [ 8 ] has explored the impact of previous stroke on TBI, in addition to previous studies on post-stroke falls.…”

“…This can better explain why the median time of stroke after TBI is higher than that of TBI after stroke. Third, ample evidence supports the increased risk of stroke after TBI [ 6 , 7 , 9 , 12 – 17 ].…”

The altered TBI fecal microbiome is stable and functionally distinct

“…In an Ohio based study, 1 in 5 adults reported a TBI with loss of consciousness and for 10% of respondents the TBI occurred before they were 15 years old ( Corrigan et al, 2018 ). TBI are associated with long-term health issues including increased risk of stroke ( Esterov et al, 2023 ), early onset dementia ( Bellomo et al, 2022 ), depression ( Lambert et al, 2022 ), and decreased olfaction ( Tai et al, 2022 ). Post-TBI sequelae frequently include fatigue and altered cognition that compromise quality of life and productivity as described by the brain injury associated fatigue and altered cognition syndrome (BIAFAC) ( Yuen et al, 2020 ).…”