[Traumatic brain injury and ischemic stroke: a delayed sequela?]

Although the conventional risk factors of ischemic stroke are numerous and the physiopathological mechanisms are well known, we believe that there may be other less common factors that have received less attention by researchers but are nonetheless just as important.

The aim of this study was to determine whether there is a long-term relationship between suffering severe traumatic brain injury (TBI) and the occurrence of ischemic stroke.

A retrospective study was performed to examine 140 cases of severe TBI attended over the last 10 years and the delayed presentation (that is, more than a year later) of an ischemic stroke. A fundamental requirement was the absence of any other known risk factors and the location of the cerebral infarct had to be ipsilateral and adjacent to the injured area of the brain.

Only three patients were detected who presented a late post-traumatic medium-sized stroke located in the cortico-subcortical region of the carotid territory, and who were diagnosed within an interval of time ranging between 11 and 16 months.

Based on the physiopathology put forward to account for the aetiological factors of diseases such as Parkinson, Alzheimer or post-traumatic epilepsy, we found reasons to consider severe TBI to be another predisposing factor of delayed ischemic stroke, with all the implications this involves in medical-legal matters. More extensive case mixes will be needed in order to confirm our proposition.