A recurrent stroke is when a person has another stroke following their first stroke. Experiencing one can have a major impact on a person’s quality of life.

Every stroke after an initial stroke is a recurrent stroke. According to a 2017 paper, recurrent strokes comprise almost a quarter of the 800,000 strokes that occur annually in the United States.

A stroke deprives the brain of oxygen and can cause significant damage that affects a person’s long-term neurological functioning. Recurrent strokes may cause additional damage, increasing the risk of disability and death. Death rates are higher after a recurrent stroke, according to a 2022 study.

Stroke symptoms can vary, and a person may have different symptoms with a recurrent stroke. People who think they may be having a recurrent stroke should seek emergency medical care.

Read on to learn more about recurrent strokes.

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Different studies have found different stroke recurrence rates. A large study from Australia and New Zealand cites a cumulative recurrence rate of 19.8% at 5 years and 26.8% at 10 years.

Having one stroke is a risk factor for having another stroke. Generally, the causes of a recurrent stroke are the same as the causes of a first stroke.

Two types of stroke can occur:

  • An ischemic stroke occurs when there is a blockage in a blood vessel, depriving the brain of blood and oxygen. The risk factors for this type include diabetes, high blood pressure, high cholesterol, smoking, and obesity.
  • A hemorrhagic stroke occurs when there is bleeding in a blood vessel that supplies blood to the vein. Injury to a major artery or a ruptured aneurysm can cause this type of stroke. Sudden injuries are a risk factor, but so is high blood pressure.

Recurrent stroke symptoms may be the same as a person’s first stroke or very different. Some stroke symptoms that warrant prompt emergency care include:

  • numbness or weakness that comes on suddenly, especially if it only affects one side of the body
  • drooping face, especially on just one side
  • sudden confusion
  • trouble speaking or making decisions
  • a sudden, severe headache that may differ from a person’s usual headache pattern
  • dizziness, lack of balance, low coordination, or trouble walking
  • difficulty seeing

Are recurrent strokes worse?

Every stroke has the potential to damage the brain, and multiple strokes may mean more extensive damage and disability.

A 2021 study that compared 40 people who had their first stroke to 40 people who had their second stroke — their first recurrent stroke — found a more extensive disability following a second stroke. Researchers found that second strokes were more dangerous overall, causing more serious symptoms.

Mortality rates are higher after a recurrent stroke. A 2022 study of people in Denmark, who experienced strokes, looked at all-cause mortality at 1 and 10 years. This means researchers looked at people who died of any cause, including causes unrelated to a stroke.

They found that first-time ischemic stroke survivors had a 1-year mortality rate of 17% and a 10-year mortality rate of 56%. After a recurrent ischemic stroke, the 1-year mortality rate increased to 25% and the 10-year mortality rate increased to 70%.

After a hemorrhagic stroke, the 1-year mortality rate was 37%, and the 10-year mortality rate was 70%. For a recurrent hemorrhagic stroke, the 1- and 10-year mortality rates were 31% and 75%, respectively.

Diagnosing a stroke requires a specialist to find evidence of either bleeding or a clot in the brain. Images from an MRI or CT scan can allow a specialist to see areas of blood and oxygen deprivation in the brain.

Doctors may also sometimes use angiography.

Prompt diagnosis and treatment can improve outcomes, so a person should go to the emergency room immediately once stroke symptoms appear.

Treatment for a recurrent stroke is the same as treatment for a first-time stroke. However, treatment varies depending on the type of stroke a person has:

Hemorrhagic vs. ischemic

A hemorrhagic stroke, which occurs when there is bleeding in or around the brain, requires a doctor to stop the bleeding. People on blood thinners need to stop these drugs immediately. However, an ischemic stroke, which happens when there is a blood clot, usually involves using blood thinners to remove the clot.

In severe situations, or if a person does not respond to blood thinners following an ischemic stroke, a doctor may perform a thrombectomy, a medical procedure that removes a blood clot.

The treatment team will also provide supportive care, including:

  • oxygen
  • treatment for high blood pressure
  • ongoing monitoring

Following a stroke, a person may need physical, occupational, or speech therapy to regain functioning.

A recurrent stroke means that a person has had their brain deprived of oxygen at least twice, increasing the chances of possible damage to the brain. Additionally, it often means that a person’s stroke risk factors have persisted. Managing controllable risk factors, such as quitting smoking, may help lower the risk of another stroke.

The prognosis is worse following a second stroke. Mortality rates are higher, and people experience more severe and long-lasting disability. Still, most people initially survive a recurrent stroke.

A person can reduce their risk of recurrent stroke by discussing their risk factors with a neurologist. The neurologist may also recommend taking blood thinners or aspirin, medication to control cholesterol, or drugs to lower blood pressure.

It is also important to manage chronic health conditions, such as diabetes and heart arrhythmias.

A person can further reduce their risk by quitting smoking, maintaining a moderate weight, and becoming more physically active.

Having a stroke is a risk factor for having another stroke, which is known as a recurrent stroke. A recurrent stroke causes additional damage, increasing the risk of death and long-term disability.

People who have had a stroke need to discuss strategies for minimizing their risk with a doctor. Lifestyle changes, medication, and ongoing monitoring could help prevent another stroke. However, if anyone is experiencing any symptoms of a stroke, they should seek immediate medical attention.