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NEUROLOGY 1998;50:196-203
© 1998 American Academy of Neurology

Recent bacterial and viral infection is a risk factor for cerebrovascular ischemia

Clinical and biochemical studies

A. J. Grau, MD, F. Buggle, H. Becher, PhD, E. Zimmermann, M. Spiel, T. Fent, M. Maiwald, MD, E. Werle, MD, M. Zorn, Dipl Ing, H. Hengel, MD and W. Hacke, MD

From the Departments of Neurology (Drs. Grau and Hacke and F. Buggle, E. Zimmerman, M. Spiel, and T. Fent), Microbiology (Dr. Maiwald), and Clinical Chemistry (Dr. Werle and M. Zorn), University of Heidelberg, Germany; the Department of Epidemiology (Dr. Becher), German Cancer Research Center, Heidelberg, Germany; and the Max von Pettenkofer-Institute for Virology(Dr. Hengel), Ludwigs-Maximilian-University, Munich, Germany.

Address correspondence and reprint requests to Dr. Armin J. Grau, Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.

We performed a case-control study to investigate the role of recent infection as stroke risk factor and to identify pathogenetic pathways linking infection and stroke. We examined 166 consecutive patients with acute cerebrovascular ischemia and 166 patients hospitalized for nonvascular and noninflammatory neurologic diseases. Control subjects were individually matched to patients for sex, age, and season of admission. We assessed special biochemical parameters in subgroups of stroke patients with and without recent infection (n = 21) who were similar with respect to demographic and clinical parameters. Infection within the preceding week was a risk factor for cerebrovascular ischemia in univariate (odds ratio [OR] 3.1; 95% confidence interval (CI), 1.57 to 6.1) and age-adjusted multiple logistic regression analysis (OR 2.9; 95% CI, 1.31 to 6.4). The OR of recent infection and age were inversely related. Both bacterial and viral infection contributed to increased risk. Infection elevated the risk for cardioembolism and tended to increase the risk for arterioarterial embolism. Stroke patients with and without preceding infection were not different with respect to factor VII and factor VIII activity, fibrin monomer, fibrin D-dimer, von Willebrand factor, C4b-binding protein, protein S, anticardiolipin antibodies, interleukin-1 receptor antagonist, soluble tumor necrosis factor-{alpha} receptor, interleukin-6, interleukin-8, and neopterin. In conclusion, recent infection is an independent risk factor for acute cerebrovascular ischemia. Its role appears to be more important in younger age groups. The pathogenetic linkage between infection and stroke is still insufficiently understood.

Received May 16, 1997. Accepted in final form July 31, 1997.




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