Subarachnoid Hemorrhage and Long-Term Stroke Risk After Traumatic Brain Injury

Morris, Nicholas; Cool, Joséphine; Merkler, Alexander E; Kamel, Hooman

doi:10.1177/1941874416675796

Cited by 9 publications

(14 citation statements)

References 36 publications

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“…The 18 studies included 2,606,379 participants and were from the United States, 16 – 24 Taiwan, 25 – 31 Croatia, 32 and Denmark. 33 All were retrospective cohort studies and eight different data sources were used ( Table 1 ), most commonly the Taiwan National Health Insurance Research Database 16 – 18 , 20 , 21 , 31 and United States Medicare administrative claims data.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies explored stroke risk post-TBI compared to non-TBI controls ( Table 1 ). 19 , 26 – 29 , 31 Eight studies investigated the association of stroke risk post-TBI with specific exposures: antidepressants; 18 , 20 statins; 21 oral anticoagulants; 16 , 33 traumatic subarachnoid hemorrhage (tSAH); 23 acupuncture; 30 and insomnia. 25 Two studies reported frequency of stroke post-TBI without a comparator 22 , 32 and two studies compared stroke incidence pre- and post-TBI.…”

Section: Resultsmentioning

confidence: 99%

“…Exposures reported in the other three studies were insomnia, 25 acupuncture, 30 and tSAH. 23 TBI patients with new onset insomnia (i.e. insomnia occurring post-TBI) had a 2-fold increased stroke risk (HR 2.28; 95% CI 1.70–3.06) compared to insomnia patients without TBI.…”

Section: Resultsmentioning

confidence: 99%

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Stroke risk following traumatic brain injury: Systematic review and meta-analysis

Turner

McMullan

Aiyegbusi

et al. 2021

International Journal of Stroke

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Aims To investigate the association between TBI and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Stroke risk following traumatic brain injury: Systematic review and meta-analysis

Turner

McMullan

Aiyegbusi

et al. 2021

International Journal of Stroke

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“…An association between TBI and stroke early after injury is not surprising, but the mechanism underlying a persisting link has not been established. 81 Various other diseases associated with TBI have a significant influence on long-term outcomes including epilepsy, 20,21 neuroendocrine disorders, 24 and neuropsychiatric illness, particularly depression. 10 A detailed discussion of these conditions is beyond the scope of this Series paper.…”

Section: Stroke and Other Neurological Disorders After Tbimentioning

confidence: 99%

The chronic and evolving neurological consequences of traumatic brain injury

Wilson

Stewart

Dams-O’Connor

et al. 2017

The Lancet Neurology

410

286

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Traumatic brain injury (TBI) can have lifelong and dynamic effects on health and wellbeing. Research on the long-term consequences emphasises that, for many patients, TBI should be conceptualised as a chronic health condition. Evidence suggests that functional outcomes after TBI can show improvement or deterioration up to two decades after injury, and rates of all-cause mortality remain elevated for many years. Furthermore, TBI represents a risk factor for a variety of neurological illnesses, including epilepsy, stroke, and neurodegenerative disease. With respect to neurodegeneration after TBI, post-mortem studies on the long-term neuropathology after injury have identified complex persisting and evolving abnormalities best described as polypathology, which includes chronic traumatic encephalopathy. Despite growing awareness of the lifelong consequences of TBI, substantial gaps in research exist. Improvements are therefore needed in understanding chronic pathologies and their implications for survivors of TBI, which could inform long-term health management in this sizeable patient population.

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“…TBI has also been associated with an increased risk for mood disorders, metabolic syndrome, diabetes mellitus, and substance use [13, 46], all of which increase vascular risk. While the possibility that persistent trauma-associated changes in vascular anatomy, cerebrovascular regulation, coagulation, and metabolism may contribute to this risk, other factors beyond unmodifiable risk associated with aging require further research, as an accurate understanding of modifiable risk factors can help with stroke prevention for those who sustain a TBI [47, 48].…”

Section: Discussionmentioning

confidence: 99%

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

Sperl¹,

Esterov²,

Ransom³

et al. 2022

Neuroepidemiology

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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.

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Subarachnoid Hemorrhage and Long-Term Stroke Risk After Traumatic Brain Injury

Abstract: Our findings do not support a role of tSAH in mediating the association between TBI and protracted stroke risk. Further study is required to elucidate the mechanisms of long-term increased stroke risk after TBI.

Cited by 9 publications

References 36 publications

Stroke risk following traumatic brain injury: Systematic review and meta-analysis

Stroke risk following traumatic brain injury: Systematic review and meta-analysis

The chronic and evolving neurological consequences of traumatic brain injury

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

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