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31-07-2011 | Stroke | Article

Stroke risk high after traumatic brain injury


Free abstract

MedWire News: People who have traumatic brain injury (TBI) should be monitored for the occurrence of stroke, especially during the first few months after injury, say researchers.

Previous studies have shown that TBI patients may develop morbidities including epilepsy, neurologic disorders, neurodegenerative diseases, neuroendocrine disorders, and psychiatric diseases.

"Our study leads the way in identifying stroke as an additional neurological problem that may arise following TBI," say Herng-Ching Lin (Taipei Medical University, Taiwan) and co-workers.

The team followed-up more than 23,000 patients with TBI and a comparison group of over 69,000 patients without brain injury, all identified in a health insurance database.

Over the 5-year follow-up, stroke occurred significantly more often in the TBI patients than in the control group, Lin et al report in the journal Stroke.

This was particularly true during the first 3 months, when 2.91% of patients with TBI had a stroke, compared with 0.30% of the control group, amounting to a 10.21-fold risk increase after accounting for income, geographic region, and comorbidities including hypertension, diabetes, and atrial fibrillation.

The increased risk was most apparent in TBI patients who had skull fracture; these patients had a 19.98-fold stroke risk increase relative to controls, whereas those without fracture had a 9.75-fold increase.

Stroke risk remained increased in the TBI patients for the whole 5-year follow-up, with rates of 4.17% at 1 year and 8.20% at 5 years, compared with 0.96% and 3.89%, respectively, in the control group. These differences equated to significant 4.61- and 2.32-fold risk increases at 1 and 5 years, respectively.

Again, the size of the risk increases was larger among patients with skull fracture than in those without.

TBI patients had a significantly increased risk for all stroke subtypes, but the highest risk increase at 5 years was for intracerebral hemorrhage, at a 6.33-fold increase among TBI patients versus the control group, whereas the risk increase for ischemic stroke was just 1.46-fold.

"Traumatic brain injury and stroke are both issues of momentous concern, because large numbers of people sustain such insults and require extensive rehabilitation in the acute and chronic stages of recovery," say Lin and colleagues.

"Our findings thus have important clinical implications in the management of patients with traumatic brain injury. More intensive medical monitoring, support, and intervention are required following a traumatic brain injury, especially during the first few months or years."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid