Intrathecal inflammation in young stroke

Autor:	Christine Holbe, Bettina von Sarnowski, Alexander Dressel, Johanna Ruhnau, Marie Süße, Malte Johannes Hannich
Rok vydání:	2019
Předmět:	Adult Male Vasculitis medicine.medical_specialty Infections Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine Prevalence Viral meningitis Humans Medicine cardiovascular diseases 030212 general & internal medicine Aged Inflammation medicine.diagnostic_test business.industry Lumbar puncture Meningoencephalitis Vasospasm General Medicine Middle Aged medicine.disease Stroke Neurology Cohort Etiology Female Neurology (clinical) business Neuroborreliosis 030217 neurology & neurosurgery
Zdroj:	Acta Neurologica Scandinavica. 140:9-16
ISSN:	1600-0404 0001-6314
DOI:	10.1111/ane.13094
Popis:	Objectives Correct identification of inflammatory etiologies of stroke is of outmost importance as they require treatment of the underlying disease. Aim of this study was to determine the prevalence of inflammatory changes in cerebrospinal fluid (CSF) observed in young cryptogenic stroke patients. Materials and methods Of 6476 records of patients diagnosed with ischemic stroke, 278 had confirmed ischemia in brain imaging and received lumbar puncture. A total of 122 were classified as young stroke (≤55 years), and 156 were classified as older stroke patients; lumbar puncture in this cohort was indicated due to atypical clinical presentation. Results An infectious etiology was detected in 2.5% of young stroke patients (n = 3: vasculitis due to opportunistic infection, vasculitis due to neuroborreliosis, secondary vasospasm after viral meningitis) and in 1.9% (n = 3) in the older stroke cohort (vasculitis due to neurotuberculosis, septic embolic ischemia, vasculitis post-haemophilus influenza meningoencephalitis). Isolated vasculitis was evident in one patient of the older stroke cohort (0.6%). Non-specific alterations in CSF included increased cell count in 10% in young and in 9.3% in the older stroke cohort. Intrathecal Ig synthesis was present in 3.4% of the younger and in 4% of the older stroke cohort. Conclusions The prevalence of an infectious etiology in young stroke is modest but slightly higher in comparison with older stroke patients. As brain imaging is not always sufficient for suspecting vasculitis, we recommend implementation of lumbar puncture in young cryptogenic stroke patients. If an infectious disease is present in ischemic stroke, it is of high therapeutic relevance.
Databáze:	OpenAIRE
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