Risk of Stroke After Traumatic Brain Injury: a Systematic Review and Meta-analysis

Overview

Journal Acta Neurol Belg

Publisher Springer

Specialty Neurology

Date 2024 Nov 22

PMID 39576497

Authors

Armin Karamian

Hana Farzaneh

Masoud Khoshnoodi

Najmeh Hosseini

Mojtaba Taheri

Brandon Lucke-Wold

Affiliations

Soon will be listed here.

Abstract

Background: Traumatic brain injury (TBI) is a major cause of death and disability in the United States. There is a suggested association between TBI and stroke, emphasizing the need for increased medical monitoring post-trauma. We conducted a systematic review and meta-analysis to investigate the link between previous TBI and the future diagnosis of any type of stroke.

Methods: A comprehensive search was conducted on PubMed, Google Scholar, and Cochrane Library to find eligible studies investigating the association between TBI and long-term risk of stroke.

Results: Out of 2,378 studies, 11 articles met the inclusion criteria for our meta-analysis. The pooled analysis showed that the patients who had a history of TBI were at greater risk for stroke than patients in the control group (random-effect HR = 1.59, 95% CI 1.37-1.85, p < 0.001, I = 97%). The risk of ischemic stroke in TBI patients was greater than in non-TBI patients (random-effect HR = 1.52, 95% CI 1.36-1.70, p < 0.001, I = 93%). Additionally, there is a strong correlation between TBI and hemorrhagic stroke (random-effect HR = 4.68, 95% CI 2.93-7.49, p < 0.001, I = 93%).

Conclusion: Our results indicate that there is a relationship between TBI and long-term risk of stroke, regardless of the stroke type. The risk is elevated in the first months post-injury and continues to be high in the years following the trauma. Individuals with moderate to severe TBI face a higher risk of developing a post-TBI stroke than those with mild TBI.

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References

Capizzi A, Woo J, Verduzco-Gutierrez M . Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management. Med Clin North Am. 2020; 104(2):213-238. DOI: 10.1016/j.mcna.2019.11.001. View

Yun Ng S, Lee A . Traumatic Brain Injuries: Pathophysiology and Potential Therapeutic Targets. Front Cell Neurosci. 2019; 13:528. PMC: 6890857. DOI: 10.3389/fncel.2019.00528. View

Miller G, DePadilla L, Xu L . Costs of Nonfatal Traumatic Brain Injury in the United States, 2016. Med Care. 2021; 59(5):451-455. PMC: 8026675. DOI: 10.1097/MLR.0000000000001511. View

Brazinova A, Rehorcikova V, Taylor M, Buckova V, Majdan M, Psota M . Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review. J Neurotrauma. 2015; 38(10):1411-1440. PMC: 8082737. DOI: 10.1089/neu.2015.4126. View

Julien J, Joubert S, Ferland M, Frenette L, Boudreau-Duhaime M, Malo-Veronneau L . Association of traumatic brain injury and Alzheimer disease onset: A systematic review. Ann Phys Rehabil Med. 2017; 60(5):347-356. DOI: 10.1016/j.rehab.2017.03.009. View

Li Y, Li Y, Li X, Zhang S, Zhao J, Zhu X . Head Injury as a Risk Factor for Dementia and Alzheimer's Disease: A Systematic Review and Meta-Analysis of 32 Observational Studies. PLoS One. 2017; 12(1):e0169650. PMC: 5221805. DOI: 10.1371/journal.pone.0169650. View

Burke J, Stulc J, Skolarus L, Sears E, Zahuranec D, Morgenstern L . Traumatic brain injury may be an independent risk factor for stroke. Neurology. 2013; 81(1):33-9. PMC: 3770205. DOI: 10.1212/WNL.0b013e318297eecf. View

Chen Y, Kang J, Lin H . Patients with traumatic brain injury: population-based study suggests increased risk of stroke. Stroke. 2011; 42(10):2733-9. DOI: 10.1161/STROKEAHA.111.620112. View

Salehi A, Zhang J, Obenaus A . Response of the cerebral vasculature following traumatic brain injury. J Cereb Blood Flow Metab. 2017; 37(7):2320-2339. PMC: 5531360. DOI: 10.1177/0271678X17701460. View

10.

Melsen W, Bootsma M, Rovers M, Bonten M . The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses. Clin Microbiol Infect. 2013; 20(2):123-9. DOI: 10.1111/1469-0691.12494. View

11.

Nyam T, Ho C, Chio C, Lim S, Wang J, Chang C . Traumatic Brain Injury Increases the Risk of Major Adverse Cardiovascular and Cerebrovascular Events: A 13-Year, Population-Based Study. World Neurosurg. 2018; 122:e740-e753. DOI: 10.1016/j.wneu.2018.10.130. View

12.

Schneider A, Peltz C, Li Y, Bahorik A, Gardner R, Yaffe K . Traumatic Brain Injury and Long-Term Risk of Stroke Among US Military Veterans. Stroke. 2023; 54(8):2059-2068. PMC: 10527414. DOI: 10.1161/STROKEAHA.123.042360. View

13.

Izzy S, Chen P, Tahir Z, Grashow R, Radmanesh F, Cote D . Association of Traumatic Brain Injury With the Risk of Developing Chronic Cardiovascular, Endocrine, Neurological, and Psychiatric Disorders. JAMA Netw Open. 2022; 5(4):e229478. PMC: 9051987. DOI: 10.1001/jamanetworkopen.2022.9478. View

14.

Izzy S, Tahir Z, Grashow R, Cote D, Jarrah A, Dhand A . Concussion and Risk of Chronic Medical and Behavioral Health Comorbidities. J Neurotrauma. 2021; 38(13):1834-1841. PMC: 8219193. DOI: 10.1089/neu.2020.7484. View

15.

Lee Y, Lee C, Huang M, Hsu C, Su Y . Increased risk of ischemic stroke in patients with mild traumatic brain injury: a nationwide cohort study. Scand J Trauma Resusc Emerg Med. 2014; 22:66. PMC: 4239396. DOI: 10.1186/s13049-014-0066-y. View

16.

Sperl M, Esterov D, Ransom J, Mielke M, Witkowski J, Brown A . Long-Term Risk of Stroke after Traumatic Brain Injury: A Population-Based Medical Record Review Study. Neuroepidemiology. 2022; 56(4):283-290. PMC: 9753901. DOI: 10.1159/000525111. View

17.

Stewart I, Amuan M, Wang C, Kennedy E, Kenney K, Werner J . Association Between Traumatic Brain Injury and Subsequent Cardiovascular Disease Among Post-9/11-Era Veterans. JAMA Neurol. 2022; 79(11):1122-1129. PMC: 9449870. DOI: 10.1001/jamaneurol.2022.2682. View

18.

Laroche M, Kutcher M, Huang M, Cohen M, Manley G . Coagulopathy after traumatic brain injury. Neurosurgery. 2012; 70(6):1334-45. DOI: 10.1227/NEU.0b013e31824d179b. View

19.

Albrecht J, Liu X, Baumgarten M, Langenberg P, Rattinger G, Smith G . Benefits and risks of anticoagulation resumption following traumatic brain injury. JAMA Intern Med. 2014; 174(8):1244-51. PMC: 4527047. DOI: 10.1001/jamainternmed.2014.2534. View

20.

Khokhar B, Simoni-Wastila L, Slejko J, Perfetto E, Zhan M, Smith G . Mortality and Associated Morbidities Following Traumatic Brain Injury in Older Medicare Statin Users. J Head Trauma Rehabil. 2018; 33(6):E68-E76. PMC: 6066463. DOI: 10.1097/HTR.0000000000000369. View