Long-term prognosis

Knowledge of prognosis is important for patients in the prime of life in order to make informed decisions about treatment, choice of education, and profession. Median first-year mortality after first-ever cerebral infarction among young adults is about 4% while median annual average mortality after the first year is about 1.7%. Likewise, median first-year recurrence rate of cerebral infarction is 2% and thereafter 1.5% per year. Risk factors for recurrent cerebral infarction include hypertension, diabetes mellitus, symptomatic atherosclerosis, and smoking. Recurrent cerebral infarction and mortality are associated with increasing number of traditional risk factors. About 10% of patients develop post-stroke seizures within 6 years of the acute stroke. Almost 90% of patients report good functional outcome (modified Rankin Scale score ≤2) on long-term follow-up, but up to 30–50% of patients do not resume employment. Many patients have cognitive impairment. Fatigue and depression are also common on long-term follow-up.