A recurrent stroke is a second stroke event occurring after a person has experienced their first stroke, typically separated by at least 28 days. Recurrent strokes account for nearly one-quarter of all strokes annually in the United States. Having a prior stroke is a major risk factor for subsequent events, with recurrence rates cited over 19% after five years and 26% after ten years. Recurrent strokes often cause more extensive brain damage, leading to a greater risk of severe disability and increased mortality compared to a first stroke. Recognizing the signs immediately is crucial because rapid treatment minimizes the potential for permanent neurological impairment.
The Classic Signs of Stroke Recurrence
The most recognized symptoms of a stroke, whether first or recurrent, are remembered using the acronym F.A.S.T. This mnemonic stands for Face drooping, Arm weakness, Speech difficulty, and Time to call emergency services. Observing any one of these signs prompts immediate action, as every minute without treatment increases the likelihood of brain damage.
The “F” refers to facial drooping, tested by asking the person to smile. If one side of the face droops or the smile appears uneven, it suggests a problem with the facial nerves. The “A” stands for arm weakness, often presenting as numbness or an inability to control a limb. Asking the person to raise both arms simultaneously reveals if one arm drifts downward, indicating a sudden loss of muscle control.
The “S” highlights speech difficulty, which can manifest as slurred words, a garbled sound, or an inability to speak coherently. Trouble understanding simple sentences is also a form of speech difficulty. Finally, the “T” emphasizes that time is critical, directing an immediate call to 911 or the local emergency number if any signs are present.
Recognizing Transient Ischemic Attacks
A Transient Ischemic Attack (TIA) presents with symptoms identical to those of a full stroke, but they are temporary. A TIA is caused by a brief blockage of blood flow to the brain, which restores itself before causing permanent tissue damage. Symptoms typically last from a few minutes up to an hour, resolving completely within 24 hours.
Despite the symptoms disappearing quickly, a TIA is a medical emergency that should never be dismissed. It serves as a strong warning sign that a full stroke may occur soon. About half of the people who suffer a stroke after a TIA do so within 48 hours of the initial event. Seeking immediate medical assessment after a TIA is necessary to identify the underlying cause and implement preventative treatment.
Understanding Symptom Variation in Subsequent Strokes
While the F.A.S.T. signs are the most common, the symptoms of a second stroke may differ from the first if the new event affects a different area of the brain. Damage from the initial stroke can mask or alter the presentation of new symptoms, making recognition more complex. For instance, a person with chronic weakness on one side might notice a new weakness on the opposite side, or their existing weakness may suddenly worsen.
Less Common Symptoms
Beyond the classic signs, a second stroke may present with less common, but serious, symptoms that come on suddenly:
- Abrupt, severe headache without any known cause, which may signal a hemorrhagic stroke.
- Sudden confusion.
- Unexpected difficulty with reading or writing.
- Acute vision changes, such as double vision or loss of sight in one or both eyes.
- Sudden loss of balance, trouble walking, dizziness, or a complete lack of coordination.
Immediate Response Protocol
The moment any sign of a recurrent stroke is observed, call 911 or the local emergency number immediately. Do not attempt to drive the person to the hospital. Emergency medical services (EMS) can begin life-saving treatment en route and notify the hospital in advance. This notification activates a specialized stroke team, ensuring the patient receives rapid treatment upon arrival.
It is important to note the exact time the symptoms were first noticed, known as the “Last Known Well Time.” This timestamp is necessary for doctors to determine eligibility for time-sensitive interventions, such as clot-busting medications. These medications are most effective when administered within a few hours of symptom onset. Providing this information accurately to the EMS team and hospital staff is crucial.