Cerebrospinal fluid cellular response in uncomplicated acute ischemic stroke

Because information regarding cerebrospinal fluid (CSF) cellular response in acute ischemic stroke (AIS) is inconclusive, we conducted the following investigation. Cell counts were performed in CSF obtained within 24 h of onset of symptoms in 118 adult patients 86 years or younger with uncomplicated AIS, after hemorrhage and mass effect were ruled out by computed tomography. In 98, CSF examination was repeated on day 7. None of the patients had evidence for systemic infection, inflammatory disease, vasculitis, leukocytosis, anemia or coagulopathy. CSF pleocytosis was defined as white blood cell (WBC) count of five or more mononuclear leukocytes (MNLs) and/or one or more polymorphonuclear leukocytes per cubic milliliter. No cells were found in 78 (66.1%) patients, 25 (21.2%) had one to four MNLs, and 15 (12.7%) had pleocytosis; none had hypoglycorrhachia. Nine patients had traumatic lumbar puncture (LP); in five of them, pleocytosis persisted after correction for red blood cell count. The highest WBC count was 15 cells per cubic milliliter. Only two patients had CSF pleocytosis on day 7; both had had traumatic LP and pleocytosis acutely. We found no correlation between CSF pleocytosis and cardiac source of embolus or type of ischemic stroke. From our data, we conclude that in uncomplicated AIS, CSF pleocytosis is rare and, when present, is mild; it has no correlation with type of stroke and is of no diagnostic value.