Systemic infection and inflammation as trigger factors of ischemic stroke

BACKGROUND: Chronic risk factors are well understood in cases of stroke as well as myocardial infarction. Till date, several triggers for stroke are still under evaluation. Researchers have previously evaluated the relationship between preceding infection and inflammation and stroke onset. PURPOSE: The purpose of study is to define the stroke triggers in a better way and to provide little more information for early intervention by controlling infections or other trigger factors METHODS: In this retrospective study, a standardized questionnaire was carried out to evaluate the signs, symptoms of preceding (<14 days) infection, physical/mental health, drug history, TIA etc. of 70 ischemic stroke patients and 80 non-stroke out-patient department patients as control groups. Important biochemical tests e.g. high sensitivity CRP, leukocytes count, blood sugar, lipid profile, etc. were also taken into consideration. Recent (15 days) prior infection, mainly respiratory tract infection and urinary tract infection, which were likely to be important stroke triggers, were compared between the ischemic stroke groups and the non-stroke patients (control group). RESULTS: It was found that respiratory tract infection is the most common type of infection (48.5%) compared with the non-stroke control group (30%). Apart from this, there were clinical evidence of infections like gastroenteritis, RTI, UTI etc which were biochemically established by leukocytosis and increased high-sensitivity C-Reactive Protein levels, well-known early diagnostic tools that have good predictive value. This study reveals that well-controlled diabetic, hypertensive or non-diabetic normotensive patients can suddenly develop ischemic stroke following recent infection as evidenced by clinical features, increased levels of high-sensitivity CRP and leukocytosis. CONCLUSION: These diagnostic tools implicate the value of early treatment of febrile illness and introduction or adjustment of doses of antiplatelet agents, antibiotics, etc. to reduce the actual stroke incidence, though it needs multicentre large community based prospective trials to evaluate stroke prone state and effective preventive measures tools at the same time.