In the current study, we aimed to evaluate cognitive impairment and physical disability after second cerebral AIS in comparison with that following the first stroke and studying the risk factors of the recurrent AIS. Forty patients in group I with first stroke and another 40 in group II with second stroke were included.
We found that the type of stroke found in both groups was matched either atherothrombotic, cardiac embolic, lacunar, stroke of other cause and stroke of unknown cause (p-value) 0.223. Two population-based studies found that recurrences were of the same subtype in almost 90% of cases [10, 11].
De la Cámara and colleagues [12] showed that the type of ischemic stroke was atherothrombotic in 62% of included in the study and in 34.6% with recurrent stroke, cardioembolic in 21.5% and 33.8%, respectively, lacunar in 11% and 21.8%, respectively, due to a hypercoagulable state in 1% of patients with first diagnosis, due to non-atherosclerotic vasculopathy in 1%, 66.7%, respectively.
A retrospective hospital-based study with a more detailed categorization of stroke subtypes suggested that stroke recurrences in lacunar and hemorrhagic index strokes are often of a different type [13], hence the hypothesis of the multifactorial origin of stroke recurrence [14].
In the current study we found that there was significant differences between two groups regarding the second stroke location to the first one in the second group of patients as different locations (non-stereotyped) present more in group II than the same location (stereotyped) with (p-value) < 0.001. The stereotyped lesions were 2 temporoparietal, 2 frontal, 1 occipital, and 1 capsular infarctions.
In Schaapsmeerders and colleagues [15] study they found that the type of lesion found was either supratentorial stroke in 79.0%, infratentorial stroke in 18.5% or bilateral in 2.5%.
In this study, we found that there was significant differences between two groups regarding size of infarction as large sized ones were present more in group II (p-value) < 0.001.
In consistent with our results Khedr and colleagues [16], showed that infarction size was larger in patients with dementia and cognitive impairment and that occurs mainly in recurrent strokes with significant difference (p-value = 0.001).
In our study, we found that there were significant differences between the two groups regarding MRS in baseline, after 2 weeks and after 3 months (p-value < 0.001) as score was higher in second group, there were significant differences in MRS in both groups from baseline and after treatment either 2 weeks or 3 months (p-value < 0.001).
Ntaios and colleagues [17] proved that embolic stroke of undetermined etiology cumulative probability of recurrence was similar to cardioembolic strokes, but higher than all the other types of non-cardioembolic stroke. These patients had a favorable functional outcome, defined as MRS ≤ 2 (62.5%), and compared to patients with cardioembolic strokes (32.2%). This explains why the MRS score was higher in recurrent patients in our study, more evidence of role of MRS in predicting unfavorable outcome like recurrent cases Long and colleagues [18] found that MRS was significantly higher in elderly patients with stroke which had bad outcome than younger patients (p-value) < 0.001.
In the current study, we found that there was significant differences between the two groups regarding NIHSS in baseline, after 2 weeks and after 3 months (p-value < 0.001) as score was higher in second group, there was significant differences in NIHSS in group I, II from baseline and after treatment either 2 weeks or 3 months (p-value < 0.001, 0.002), respectively. Alemam and colleagues [19] showed that there was there was a highly statistically significant correlation between NIHSS score and outcome of AIS (p ≤ 0.0001).
We found that there were significant differences between the two groups regarding MINI COG in baseline, after 2 weeks and after 3 months (p-value 0.033, < 0.001), respectively, there was significant differences in MINI COG in group I, II from baseline and after treatment either 2 weeks or 3 months (p-value < 0.001, 0.002), respectively.
This goes with Borson and colleagues [20], as they found that MINI COG was sensitive to recurrent stroke and any dementia that occurred. This explained why in our study its level was much higher in the recurrent group.
Cao and colleagues [21] investigated 40 young patients with ischemic stroke and assessed other domains and found that language comprehension, reasoning, and verbal memory to be most affected. Processing speed was not assessed in these patients.
There were limitations in this study, such as the short duration of follow-up, the number of patients should be increased in further studies, inclusion of patients as first and second stroke should consider imaging as some clinically presented strokes could have previous silent infarcts which might affect the results, a depression scale should be added, and some risk factors like smoking can be a confounding issue that relates to poorer outcome in the second group.
