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Friday, November 28, 2014
Once an 81 year-old woman has had a severe hemorrhagic stroke, what are the chances that she will have one again, if her blood pressure is now controlled?
I cannot provide an easy answer, as it depends at least in part on the type of stroke we are talking about. The first question is whether it was a hemorrhage into the brain, or an ischemic stroke that had hemorrhage in it. This can be a difficult distinction, even for stroke experts.
If it is a hemorrhage into the brain, the recurrence rate then depends upon the cause of the hemorrhage. If it was thought to be due to hypertension (usually affecting the deep structures of the brain), then the rate of recurrence is thought to be low (on the order of 1-3%/year). However, if the hemorrhage was thought to be due to deposition of amyloid (amyloid is a protein that accumulates in the brain with aging, causing 'amyloid angiopathy' with hemorrhage, amyloid is also associated with dementia) then the rate may be substantially higher.
If it is an ischemic stroke with hemorrhage, then the risk is dependent upon a variety of risk factors. The American Stroke Association has a computer based algorithm where patients can enter their risk factors and obtain an estimate of their risk for stroke (you can find by doing a web search).
In any case, it is a good idea to control risk factors such as high blood pressure, as this well undoubtedly lower your risk for recurrent stroke.
I hope this helps.
Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati