Background:
Many stroke survivors develop late medical complications that impair function and return to pre-stroke responsibilities. Optimal strategies for detection of late complications after stroke (LCAS) have not been established.
Methods:
This retrospective cohort study included patients age 18-50 with acute ischemic stroke, transient ischemic attack, or non-traumatic intracerebral hemorrhage with outpatient evaluations in the Stroke Clinic at a tertiary care center within the first year after stroke between 1/2016-12/2017. Demographics, comorbidities, stroke subtype, and presence of LCAS were obtained from the EHR. “Active surveillance” was defined as use of a structured questionnaire (by one neurologist) to elicit symptoms suggesting the presence of LCAS including headache, seizures, lethargy, mood disorders, cognitive impairment, central pain, insomnia, spasticity, dystonia, and orthostasis. Patients were assigned to outpatient visits with neurologists based on prior inpatient encounters while the neurologists were on-call for stroke. Differences between detection of LCAS in patients with active surveillance or usual care were compared at two time points (0-3 months, 3-12 months).
Results:
One hundred twenty-one young stroke survivors were included in this study, of which 37% (45) underwent active surveillance. There were no differences in baseline characteristics between the two groups. Participants undergoing active surveillance were more likely to have at least one LCAS detected (77% vs 49% at 0-3 months, p=0.02; 81% vs. 54% at 3-12 months, p=0.008). Active surveillance was significantly more likely to detect symptoms suggesting headache, seizures, lethargy, mood disorders, cognitive impairment, insomnia, and orthostasis.
Conclusion:
Active surveillance leads to higher rates of early detection of LCAS in young stroke survivors. Validation of screening tools for LCAS and assessment of an active surveillance approach in a prospective cohort are needed to improve the management of these conditions among stroke survivors.
The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work