What is the likelihood of stroke symptom recurrence after a fall with head trauma?

From the Guidelines

The likelihood of stroke symptom recurrence after a fall with head trauma is high and requires immediate medical attention to prevent further complications and improve outcomes. According to the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack, the risk of recurrent stroke in the short term and long term varies by stroke mechanism, with a risk of stroke within 90 days after a first stroke being approximately 5% 1.

Key Considerations

• The risk of stroke recurrence can vary greatly depending on the mechanism, with symptomatic carotid stenosis and atrial fibrillation being important to diagnose in a timely fashion to allow implementation of specific treatments with proven efficacy 1.
• Falls, even minor ones, can lead to significant morbidity and mortality in the geriatric population, and the evaluation of a patient who has fallen involves not only a thorough assessment for traumatic injuries but also an assessment of the cause of the fall and an estimation of future fall risk 1.
• Head trauma can disrupt blood clotting mechanisms and increase bleeding risk, especially if the patient is on anticoagulants or antiplatelet medications, making prompt medical evaluation crucial to prevent further complications.

Recommendations

• If stroke symptoms recur after a fall with head trauma, seek emergency medical attention immediately by calling 911 or going to the nearest emergency room.
• Medical professionals will likely perform imaging studies such as a CT scan or MRI to assess for bleeding, new infarction, or other brain injuries, and may also check vital signs, perform neurological examinations, and possibly administer medications like tissue plasminogen activator (tPA) if within the treatment window.

From the Research

Stroke Symptom Recurrence After a Fall with Head Trauma

• The likelihood of stroke symptom recurrence after a fall with head trauma is a significant concern, with various studies investigating the risk factors and management strategies 2, 3, 4, 5, 6.
• A study published in 2023 found that patients with comorbidities of dementia, stroke, and smoking were significantly more likely to sustain a new injury leading to a repeat ED visit within 14 days after an initial fall-related head trauma 2.
• Another study from 2011 highlighted the importance of prompt treatment and intervention to reduce the risk of recurrent stroke, with only approximately 5% of stroke patients receiving appropriate therapy in a timely manner 3.
• Falls are a common complication after stroke, with balance and gait deficits being major risk factors 4, 5, 6.
• The use of task-oriented exercises and technological advances in assistive devices may be beneficial in preventing falls in post-stroke patients 4.
• A retrospective study of 56 falls in 41 stroke patients hospitalized for rehabilitation identified reduced muscular tone, paralysis, and hypoesthesia as significant risk factors for falls 5.
• A systematic literature review found that depression, cognitive impairments, and fear of falling are important risk factors and consequences of falls after stroke, and that exercising balance and using fall risk indicators such as the Barthel Index and the Timed-Up-and-Go test may be effective in reducing the risk of falling 6.