A study of Recurrent Stroke.

Stroke was defined according to the World Health Organization criteria as “rapidly developing symptoms and/or signs of focal, and at times global, loss of cerebral function, with symptoms lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin.” The term “global” refers mainly to subarachnoid hemorrhage. Recurrent stroke is defined as a stroke, in which there was clinical evidence of the sudden onset of a new focal neurological deficit with no apparent cause other than that of vascular origin (ie, the deficit could not be ascribed to an intercurrent acute illness, epileptic seizure, or toxiceffect) occurring at any time after the index stroke; or there was clinical evidence of the sudden onset of an exacerbation of a previous focal neurological deficit with no apparent cause other than that of vascular origin occurring 21 days after the index stroke. Each recurrent stroke was classified as ischemic, hemorrhagic, or of undetermined nature on the basis of a CT or MRI scan performed within 28 days of recurrence or autopsy examination of the brain. Etiologic subtypes of ischemic stroke were defined according to Standardized criteria. Recurrent strokes account for considerable amount of mortality and morbidity. Pathological subtype breeds true to the index stroke. Middle cerebral artery territory is the commonest site involved in recurrent stroke. Hypertension was the risk factor found in majority of the recurrent episodes. Presence of three risk factors confers the maximum risk of development of subsequent strokes. All patients deserve a repeat clinical examination and relevant investigations. This enables to identify new risk factors in cryptogenic strokes and confirm existing and persisting / corrected risk factors. Aggressive treatment of risk factors will prolong the stroke free interval and prevent the occurrence of recurrent stroke. Balance of benefits and risks associated with use of various secondary prevention treatments has to be decided on individual basis