Acute Ischemic Stroke after Moderate to Severe Traumatic Brain Injury

Robert G. Kowalski, Juliet K. Haarbauer-Krupa, Jeneita M. Bell, John D. Corrigan, Flora Hammond, Michel T. Torbey, Melissa C. Hofmann, Kristen Dams-O'Connor, A. Cate Miller, Gale G. Whiteneck

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background and Purpose - Traumatic brain injury (TBI) leads to nearly 300 000 annual US hospitalizations and increased lifetime risk of acute ischemic stroke (AIS). Occurrence of AIS immediately after TBI has not been well characterized. We evaluated AIS acutely after TBI and its impact on outcome. Methods - A prospective database of moderate to severe TBI survivors, admitted to inpatient rehabilitation at 22 Traumatic Brain Injury Model Systems centers and their referring acute-care hospitals, was analyzed. Outcome measures were AIS incidence, duration of posttraumatic amnesia, Functional Independence Measure, and Disability Rating Scale, at rehabilitation discharge. Results - Between October 1, 2007, and March 31, 2015, 6488 patients with TBI were enrolled in the Traumatic Brain Injury Model Systems National Database. One hundred and fifty-nine (2.5%) patients had a concurrent AIS, and among these, median age was 40 years. AIS was associated with intracranial mass effect and carotid or vertebral artery dissection. High-velocity events more commonly caused TBI with dissection. AIS predicted poorer outcome by all measures, accounting for a 13.3-point reduction in Functional Independence Measure total score (95% confidence interval, -16.8 to -9.7; P<0.001), a 1.9-point increase in Disability Rating Scale (95% confidence interval, 1.3-2.5; P<0.001), and an 18.3-day increase in posttraumatic amnesia duration (95% confidence interval, 13.1-23.4; P<0.001). Conclusions - Ischemic stroke is observed acutely in 2.5% of moderate to severe TBI survivors and predicts worse functional and cognitive outcome. Half of TBI patients with AIS were aged ≤40 years, and AIS patients more often had cervical dissection. Vigilance for AIS is warranted acutely after TBI, particularly after high-velocity events.

Original languageEnglish (US)
Pages (from-to)1802-1809
Number of pages8
JournalStroke
Volume48
Issue number7
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

Fingerprint

Stroke
Amnesia
Confidence Intervals
Survivors
Dissection
Traumatic Brain Injury
Rehabilitation
Vertebral Artery Dissection
Outcome Assessment (Health Care)
Databases
Carotid Arteries
Inpatients
Hospitalization
Incidence

Keywords

  • acute ischemic stroke
  • cognition
  • outcome
  • stroke
  • traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Kowalski, R. G., Haarbauer-Krupa, J. K., Bell, J. M., Corrigan, J. D., Hammond, F., Torbey, M. T., ... Whiteneck, G. G. (2017). Acute Ischemic Stroke after Moderate to Severe Traumatic Brain Injury. Stroke, 48(7), 1802-1809. https://doi.org/10.1161/STROKEAHA.117.017327

Acute Ischemic Stroke after Moderate to Severe Traumatic Brain Injury. / Kowalski, Robert G.; Haarbauer-Krupa, Juliet K.; Bell, Jeneita M.; Corrigan, John D.; Hammond, Flora; Torbey, Michel T.; Hofmann, Melissa C.; Dams-O'Connor, Kristen; Miller, A. Cate; Whiteneck, Gale G.

In: Stroke, Vol. 48, No. 7, 01.07.2017, p. 1802-1809.

Research output: Contribution to journalArticle

Kowalski, RG, Haarbauer-Krupa, JK, Bell, JM, Corrigan, JD, Hammond, F, Torbey, MT, Hofmann, MC, Dams-O'Connor, K, Miller, AC & Whiteneck, GG 2017, 'Acute Ischemic Stroke after Moderate to Severe Traumatic Brain Injury', Stroke, vol. 48, no. 7, pp. 1802-1809. https://doi.org/10.1161/STROKEAHA.117.017327
Kowalski RG, Haarbauer-Krupa JK, Bell JM, Corrigan JD, Hammond F, Torbey MT et al. Acute Ischemic Stroke after Moderate to Severe Traumatic Brain Injury. Stroke. 2017 Jul 1;48(7):1802-1809. https://doi.org/10.1161/STROKEAHA.117.017327
Kowalski, Robert G. ; Haarbauer-Krupa, Juliet K. ; Bell, Jeneita M. ; Corrigan, John D. ; Hammond, Flora ; Torbey, Michel T. ; Hofmann, Melissa C. ; Dams-O'Connor, Kristen ; Miller, A. Cate ; Whiteneck, Gale G. / Acute Ischemic Stroke after Moderate to Severe Traumatic Brain Injury. In: Stroke. 2017 ; Vol. 48, No. 7. pp. 1802-1809.
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abstract = "Background and Purpose - Traumatic brain injury (TBI) leads to nearly 300 000 annual US hospitalizations and increased lifetime risk of acute ischemic stroke (AIS). Occurrence of AIS immediately after TBI has not been well characterized. We evaluated AIS acutely after TBI and its impact on outcome. Methods - A prospective database of moderate to severe TBI survivors, admitted to inpatient rehabilitation at 22 Traumatic Brain Injury Model Systems centers and their referring acute-care hospitals, was analyzed. Outcome measures were AIS incidence, duration of posttraumatic amnesia, Functional Independence Measure, and Disability Rating Scale, at rehabilitation discharge. Results - Between October 1, 2007, and March 31, 2015, 6488 patients with TBI were enrolled in the Traumatic Brain Injury Model Systems National Database. One hundred and fifty-nine (2.5{\%}) patients had a concurrent AIS, and among these, median age was 40 years. AIS was associated with intracranial mass effect and carotid or vertebral artery dissection. High-velocity events more commonly caused TBI with dissection. AIS predicted poorer outcome by all measures, accounting for a 13.3-point reduction in Functional Independence Measure total score (95{\%} confidence interval, -16.8 to -9.7; P<0.001), a 1.9-point increase in Disability Rating Scale (95{\%} confidence interval, 1.3-2.5; P<0.001), and an 18.3-day increase in posttraumatic amnesia duration (95{\%} confidence interval, 13.1-23.4; P<0.001). Conclusions - Ischemic stroke is observed acutely in 2.5{\%} of moderate to severe TBI survivors and predicts worse functional and cognitive outcome. Half of TBI patients with AIS were aged ≤40 years, and AIS patients more often had cervical dissection. Vigilance for AIS is warranted acutely after TBI, particularly after high-velocity events.",
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AU - Hammond, Flora

AU - Torbey, Michel T.

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