CASE REPORT

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RECURRENT STROKE: WHAT HAVE WE LEARNT?

Learning issues

Primary prevention is the most cost effective way in prevention of TIA or stroke.  As a primary care physician and front liners we should counsel our patients on lifestyle modifications that include regular exercise, low salt diet and dietary changes, weight reduction, and behavioural modification such as cessation of smoking to prevent cardiovascular and cerebrovascular risk factors. Hypertension is the most prevalent and modifiable risk factor of stroke. Early detection and treatment of hypertension can substantially reduce the risk of stroke. We should carry out opportunistic screening for risk factors, and in the presence of one risk factor, positive family history, and obesity we should screen for other co morbidities. We should perform regular monitoring of these risk factors and optimise the treatment until target levels are achieved.

However once patient had experienced any stroke event, we should prevent further episodes of stroke. In addition to lifestyle modifications, we should optimize the treatment for hypertension, diabetes mellitus and dyslipidemia in order to achieve target levels. In cases of ischaemic stroke patients should be on antiplatelet agents. We should also think of intracranial carotid stenosis in patients with recurrent stroke, and hence timely investigation and early referral to neurologist are paramount.

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