Long-Term Risk of Stroke after Traumatic Brain Injury: A Population-Based Medical Record Review Study

Abstract

Objective To reliably inform secondary prevention strategies and reduce morbidity and mortality after traumatic brain injury (TBI), we sought to understand the long-term risk of stroke after TBI in patients aged 40 years and older in comparison to age- and sex-matched referents from a population-based cohort. Materials and Methods TBI cases in Olmsted County, Minnesota from January 1, 1985 to December 31, 1999 were confirmed by manual review, classified by injury severity and mechanism, and non-head trauma was quantified. Each TBI case was matched to 2 sex- and age-matched population-based referents without TBI and with similar severity non-head trauma. Records of cases and referents were manually abstracted to confirm stroke diagnosis. Stroke events during initial hospitalization for TBI were excluded. Results In total, 1,410 TBI cases were confirmed, 61% classified as Possible TBI (least severe, consistent with concussive), with the most common mechanism being falls. There were 162 stroke events among those with TBI (11.5%), and 269 among referents (9.5%). Median time to stroke from the index date for those with TBI was 10.2 years (Q1-Q3 5.2 – 17.8), and for referents 12.1 years (Q1-Q3 6.2-17.3), P = 0.215. All-severity TBI was associated with increased risk of stroke (HR: 1.32, 95% CI: 1.06–1.63, P = 0.011), but only Definite TBI (consistent with moderate-severe) was associated with significant risk (HR: 2.20, 95% CI: 1.04-4.64, P = 0.038) when stratified by severity. Discussion/Conclusion By confirming TBI cases, stroke diagnoses, and injury severity classification using manual review with levels of accuracy not previously reported, these results indicate moderate-severe TBI increases long-term risk for stroke. These findings confirm the need to regularly assess long-term vascular risk after TBI to implement disease prevention strategies.

Risk of Long-Term Ischemic Stroke in Patients With Traumatic Brain Injury and Incident Hypertension

“…Emerging data suggest that TBI is associated with increased risk of ischemic stroke, 1 , 6 , 7 as is hypertension. 8 Previously, the factors that mediate the effect of TBI on ischemic stroke had not been evaluated.…”

Prevalence of Cardiovascular Conditions After Traumatic Brain Injury: A Comparison Between the Traumatic Brain Injury Model Systems and the National Health and Nutrition Examination Survey

“…Furthermore, those with definite TBI (consistent with moderate–severe TBI) were 2.20 (95% CI, 1.04–4.64) more likely to have a stroke than those without TBI. 22 Heart disease, hypertension, hyperlipidemia, and diabetes are known risk factors for stroke in the general population, 37 and cooccurring cardiovascular conditions with TBI may further increase the risk of stroke in this population.…”

“…Individuals with TBI are at increased risk of stroke, both ischemic and hemorrhagic stroke, even years after TBI. 19 , 20 , 21 , 22 Similarly, CVD and other cardiovascular risk factors, notably diabetes, hypertension, and obesity in middle age, are associated with increased rates of dementia and cognitive decline in the general (non‐TBI) population. 23 , 24 , 25 , 26 , 27 Individuals with TBI are already at increased risk of long‐term cognitive impairments 10 and may be more susceptible to the detrimental impacts of cardiovascular conditions on late life cognitive decline.…”

Modulating Effects of Zingiberaceae Phenolic Compounds on Neurotrophic Factors and Their Potential as Neuroprotectants in Brain Disorders and Age-Associated Neurodegenerative Disorders: A Review

“…Patients with a history of TBI are at an increased risk of developing proteinopathy, which is a pathological feature of neurodegenerative disorders. Moderate to severe TBI also increases the long-term risk of stroke [281], particularly in older adults [282]. There is a need to find treatment to improve brain plasticity which could allow greater recovery after cerebral ischemia and injury.…”