Everything You Need to Know About Stroke Recrudescence

 Did your competent? doctor inform you of this possible problem? I'm sure your doctor knew of all this earlier research if they were competent at all!

Recrudescence of deficits after stroke: clinical and imaging phenotype, triggers, and risk factors September 2017

Recrudescence of old stroke deficits among transient neurological attacks February 2019

Post-Stroke Recrudescence: A Case Report and Literature Review  August 2023

Post-stroke recrudescence from infection: an immunologic mechanism?  July 2018

Clinical Features, Triggers, and Risk Factors Identified for Post-Stroke Recrudescence September 2017

The latest here:

Everything You Need to Know About Stroke Recrudescence

Stroke recrudescence is the temporary return of previous stroke symptoms, without new stroke damage. It’s possible to mistake them for a new stroke, so it’s best to seek emergency care.

Post-stroke recrudescence (PSR), or simply “stroke recrudescence,” is when old stroke symptoms temporarily come back. Factors such as infection, dehydration, or certain medications often trigger it.

Understanding stroke recrudescence is important for accurate diagnosis and proper care, preventing unnecessary interventions.

What causes a recrudescence of stroke?

Stroke recrudescence, or post-stroke recrudescence (PSR), typically various physiological stressors trigger it. Some common causes include:

• infection (due to the body’s inflammatory response)
• hypotension (low blood pressure)
• hyponatremia (low sodium levels in the blood)
• insomnia
• stress
• benzodiazepine use
• dehydration
• overexertion

PSR can occur after both ischemic and hemorrhagic strokes and is more common in people who have had larger strokes. The condition is fairly common, affecting about 10% of people seeking medical attention for transient neurological issues.

One study looked at 153 participants who experienced PSR years after their initial stroke. The symptoms usually came back about 4 years after the first stroke, lasted less than a day, and were generally mild. The study found that females, African Americans, and people with certain health conditions like diabetes and high cholesterol were more likely to experience PSR.

What is the difference between recrudescence and relapse?

• Recrudescence is the temporary return of stroke symptoms that were previously resolved, often triggered by factors like infections or stress. It doesn’t involve new brain damage and typically improves once you address the trigger.

• Relapse refers to the recurrence or worsening of stroke symptoms after a period of relief. This often suggests a new stroke or progression of the underlying condition and may require intensified treatment.

While “recrudescence” specifically describes the return of old symptoms without new damage, “relapse” is sometimes used more broadly and less precisely, especially in informal contexts.

Symptoms of stroke recrudescence

The symptoms of stroke recrudescence typically include the temporary reappearance or worsening of neurological deficits that were present after the original stroke.

These symptoms can vary depending on the area of the brain that was affected by the original stroke but generally include:

• Weakness or numbness: Often on one side of the body (e.g., face, arm, leg).
• Speech difficulties: Difficulty speaking or understanding speech (e.g., slurred speech, difficulty finding words).
• Vision problems: Temporary vision changes (e.g., blurred vision, loss of vision in one or both eyes).
• Coordination problems: Difficulty with balance, walking, or coordination.
• Sensory changes: Altered sensation (e.g., tingling or loss of sensation on one side of the body).

These symptoms are usually mild, abrupt, and resolve within a short period, often less than 24 hours. They mimic the symptoms of the initial stroke but don’t indicate a new stroke or brain injury.

Experts consider recrudescence as a common stroke mimic, meaning it can look like a new stroke but isn’t. Stroke mimics makeup about 30% of stroke-related cases, with 42% of these people having a history of previous strokes.

Diagnosing post-stroke recrudescence

Diagnosing PSR is challenging because there are no specific blood tests or imaging results for it. Additionally, since PSR symptoms are temporary and can appear in individuals with existing vascular risk factors, distinguishing them from those of a new stroke, a transient ischemic attack (TIA), or other conditions can be difficult.

Key features of PSR include a worsening of old stroke symptoms, identifiable stressors (e.g., dehydration, stress, infection), and a history of chronic (long-term) stroke on brain scans, with no new acute lesions visible on imaging.

Diagnosis involves several steps to distinguish it from other conditions that may appear similar. Here’s how healthcare professionals typically do it:

• Review medical history and symptoms: They examine past stroke history and current symptoms, focusing on the return of previously resolved deficits and recent triggers.
• Neurological exam: They assess symptoms to see if they match prior deficits.
• MRI or CT scan: They check for new lesions or changes.
• Diffusion-weighted imaging: They rule out new acute ischemic events, which should show no new abnormalities in recrudescence.
• Rule out other conditions: They differentiate from conditions like TIAs, seizures, or migraine. Unlike TIAs, people with PSR generally have fewer cardiovascular problems.
• Identify triggers: They look for recent factors such as infections, stress, or medication changes that might have caused symptom recurrence.

How long does recrudescence last?

Stroke recrudescence typically lasts a short time, usually resolving within hours to a day. Symptoms often start suddenly but ease completely once you receive treatment for an underlying trigger, such as an infection or electrolyte imbalance.