Stroke Recurrence: Can You Have Multiple Strokes?

Strokes are a life-threatening medical emergency caused by interrupted blood flow to the brain, resulting from blocked blood vessels or bleeding in the brain. Every year, more than 795,000 people in the US experience a stroke, with about 25% of these occurring in individuals who have previously had a stroke. While there is no exact number of strokes a person can have and survive, each stroke inflicts damage on the brain, increasing the risk of disability and death. Recurrent strokes, or strokes following an initial stroke, account for almost a quarter of the 800,000 strokes that occur annually in the US. The risk of a second stroke is heightened, and it is crucial to seek immediate medical attention if any stroke symptoms appear.

Recurrent strokes: causes, symptoms, and treatment

Overview

A recurrent stroke occurs when a person experiences a second stroke following their first. Experiencing a recurrent stroke can significantly impact a person's quality of life. Every subsequent stroke increases the risk of potential brain injury and long-term disability, as it indicates multiple episodes of oxygen deprivation in the brain.

Causes

According to studies, having a stroke puts you at risk of having another one. The causes of a recurrent stroke are generally the same as those of an initial stroke. These include:

• Diabetes
• High blood pressure
• High cholesterol
• Smoking
• Obesity
• Sleep apnea
• Heart defects
• High blood sugar
• Brain aneurysms
• Brain tumours
• Alcohol use disorder
• Migraines
• Drug misuse

Symptoms

The symptoms of a recurrent stroke may be similar or different from those of the first stroke. Some of the signs and symptoms that require immediate emergency medical care include:

• A sudden, severe headache that may differ from a typical headache
• Numbness or weakness, especially if it affects only one side of the body
• Drooping on one side of the face
• Difficulty speaking or making decisions
• Poor coordination or trouble walking
• Loss of balance
• Dizziness

Treatment

The treatment for a recurrent stroke is similar to that of an initial stroke and depends on the type of stroke a person experiences:

• Ischemic stroke: This type of stroke occurs due to a blockage in a blood vessel. Treatment involves the use of blood thinners or thrombolytics to dissolve clots and restore circulation. In some cases, a thrombectomy may be performed to remove the clot.
• Hemorrhagic stroke: This type of stroke occurs due to bleeding in a blood vessel. Treatment focuses on stopping the bleeding and reducing blood pressure to prevent further bleeding. Surgery may be necessary to relieve pressure on the brain caused by accumulated blood.

In addition to these treatments, supportive care is provided, including treatment for high blood pressure and rehabilitation services such as physical, occupational, or speech therapy to help regain functioning.

Prevention

To prevent recurrent strokes, it is important to discuss risk factors with a neurologist and make necessary lifestyle changes. This may include quitting smoking, maintaining a healthy weight, increasing physical activity, and managing chronic health conditions such as diabetes and heart arrhythmias. Medications such as blood thinners, aspirin, cholesterol-lowering drugs, or blood pressure-lowering drugs may also be recommended.

Risk factors for a recurrent stroke

Having multiple strokes increases the risk of having another one. According to a 2022 study, the chances of having another stroke after the initial one are as follows:

• Within 1 year: 11%
• Within 5 years: 26%
• Within 10 years: 39%
• Within 15 years: 47%

The risk of having another stroke is also influenced by the type of stroke a person has had. A hemorrhagic stroke, which occurs when blood leaks from an artery in the brain, carries a greater risk of death and recurrence than an ischemic stroke, which is caused by blood clots or other particles blocking a blood vessel.

There are several factors that can increase a person's risk of dying from a stroke or having another one. These include:

• Age: The risk of having a stroke doubles every 10 years from the age of 55.
• Race and ethnicity: In the US, Black, Indigenous, and Hispanic people have higher mortality rates from stroke than white people. This is largely due to unequal access to and quality of healthcare.
• Sex: More females than males experience stroke, and females of all ages are more likely to die from stroke than males. Pregnancy and hormonal birth control can also influence stroke risk.
• Health conditions: People with certain health conditions, such as atrial fibrillation, are more likely to have a severe stroke and are at a higher risk of stroke recurrence.

Additionally, modifiable risk factors such as diabetes mellitus, hypertension, and atrial fibrillation have been associated with stroke recurrence in some studies.

Preventing a second stroke

Strokes are a serious medical condition that can have life-altering consequences. While the impact of a first stroke can be significant, the effects of subsequent strokes can be even more damaging. It is therefore crucial to take steps to prevent a second stroke. Here are some key strategies to reduce the risk:

Manage Underlying Health Conditions

Identifying and managing the underlying causes of a stroke are essential for preventing another one. This includes controlling high blood pressure, which is a significant risk factor for hemorrhagic strokes. Medication and lifestyle changes, such as reducing salt intake, can help lower blood pressure. Additionally, managing conditions like Type 2 diabetes, high cholesterol, and atrial fibrillation can reduce the likelihood of a second stroke.

Maintain a Healthy Diet

Adopting a healthy diet is crucial for overall health and can significantly reduce the risk of a second stroke. The Mediterranean diet, which includes abundant fruits and vegetables, whole grains, and healthy fats like olive oil, is particularly recommended. This diet is associated with a lower risk of stroke and can help manage conditions like high cholesterol. It is also important to limit alcohol consumption and avoid frying foods.

Take Prescribed Medications

Taking prescribed medications as directed by your doctor is vital for managing stroke risk factors and preventing a second stroke. Do not skip or reduce doses unless instructed by your doctor. Medications can help control cholesterol, blood pressure, and diabetes, reducing the chances of a recurrent stroke. It is also important to not discontinue medications without medical advice.

Stop Smoking

Smoking is a significant risk factor for strokes, as it increases stress on the blood vessels in the brain and heart. Quitting smoking can reduce this dangerous stress and lower the risk of not only a second stroke but also a range of cancers.

Engage in Regular Physical Activity

Regular physical activity can help reduce the risk of a second stroke. It is recommended to engage in moderate-intensity aerobic activity for at least 10 minutes, four times a week, or vigorous-intensity aerobic activity for at least 20 minutes, twice a week. Walking, bicycling, and other forms of exercise can improve overall health and lower stroke risk.

Treat Other Stroke Risk Factors

Atrial fibrillation, or afib, is an irregular heartbeat that increases the risk of ischemic strokes. Treating afib with medications and maintaining a healthy heart rate through a heart-healthy diet, exercise, weight management, and avoiding excess alcohol can help reduce the likelihood of a second stroke. Additionally, managing conditions like diabetes, high blood pressure, and high cholesterol are crucial in preventing another stroke.

Seek Support

Experiencing a stroke can lead to depression and frustration due to changes in cognitive abilities. It is important to seek support through therapy, such as speech, occupational, or physical therapy, and to consider joining support groups for stroke survivors and their loved ones. Addressing mental health concerns can help in the overall recovery process and improve well-being.

Act Fast at the First Sign of a Stroke

Time is critical when it comes to strokes. If you or someone around you exhibits stroke symptoms, call emergency services immediately. The quicker a stroke is treated, the better the chances of recovery without disability. Know the warning signs, such as loss of balance, sudden loss of vision, muscle weakness or paralysis, and speech difficulties, and act fast to improve outcomes and prevent long-term damage.

The impact of multiple strokes

Multiple strokes can have a significant impact on a person's quality of life and long-term neurological functioning. The risk of disability and death increases with each stroke, as the brain sustains further damage and the chances of recovery diminish.

Brain Damage and Disability

Each stroke injures the brain, causing brain cells to die due to a lack of blood and oxygen. This can result in permanent damage, depending on the area of the brain affected. The more strokes a person has, the greater the risk of lasting damage and disability. For example, a person may experience muscle weakness or paralysis, loss of speech, blurred or double vision, loss of coordination, and emotional instability.

Mortality Rates

Mortality rates are higher after a recurrent stroke. A 2022 study found that after an initial ischemic stroke, the 1-year mortality rate was 17%, while the 10-year rate was 56%. Following a recurrent ischemic stroke, these rates increased to 25% and 70%, respectively. For hemorrhagic strokes, the 1-year mortality rate was 37%, and the 10-year rate was 70%. Recurrent hemorrhagic strokes had even higher mortality rates of 31% and 75%.

Long-term Complications

Multiple strokes can lead to various medical, musculoskeletal, and psychosocial complications that add to the original disability caused by the initial stroke. These include:

• Urinary and fecal incontinence
• Cognitive impairment and dementia
• Musculoskeletal problems, such as spasticity, hypertonicity, and hemiplegic shoulder pain
• Post-stroke depression and emotional lability

Impact on Daily Life

The effects of multiple strokes can be devastating, impacting a person's independence and quality of life. It can affect their ability to perform daily tasks, communicate, and participate in social activities. The risk of another stroke is also higher after the first, so managing controllable risk factors and making lifestyle changes are crucial to prevent further strokes and reduce the impact on the person's life.

How to recognise the signs of a stroke

Recognising the signs of a stroke is crucial, as it is a life-threatening condition that requires immediate medical attention. To identify a stroke, you can use the acronym BE FAST or simply FAST to remember the key symptoms:

• Balance: Watch out for a sudden loss of balance or coordination.
• Eyes: Look for a sudden loss of vision in one or both eyes, or double vision.
• Face: Ask the person to smile and observe if one side of their face droops, indicating muscle weakness or paralysis.
• Arms: Check for muscle weakness on one side by asking the person to raise both arms. If one arm drifts downward, it could be a sign of a stroke.
• Speech: Strokes often cause speech difficulties, such as slurred speech or trouble finding the right words.
• Time: Time is critical. If you observe any of the above signs, call emergency services immediately. Note the time the symptoms started, as this information is crucial for healthcare providers.

In addition to the FAST acronym, there are other signs and symptoms that may indicate a stroke:

• Numbness or weakness down one side of the body.
• Confusion, memory loss, or difficulty thinking.
• Severe headache with no known cause.
• Dizziness or vertigo.
• Nausea and vomiting.
• Emotional instability and personality changes.

It is important to remember that stroke symptoms can vary depending on the area of the brain affected. If you or someone you know is exhibiting any of these signs, don't wait to seek medical help. Call your local emergency number right away.

Frequently asked questions