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Infection as a Stroke Risk Factor and Determinant of Outcome After Stroke
Mitchell S V Elkind1,2, Amelia K Boehme1,2, Craig J Smith3
1Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY. (M.S.V.E., A.K.B.).
Insights
Infections, including COVID-19, can trigger strokes and worsen cognitive decline. Stroke survivors are also more susceptible to infections, creating a dangerous cycle impacting long-term brain health.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- The link between infection and stroke is increasingly recognized, particularly during the COVID-19 pandemic.
- This relationship is bidirectional: infections increase stroke risk, and stroke can lead to immune suppression and subsequent infections.
- Emerging evidence highlights the impact of post-stroke immune changes on long-term cognitive outcomes, including neurodegeneration and dementia.
Purpose of the Study:
- To review the role of acute and chronic infections as stroke triggers.
- To examine the bidirectional relationship between stroke and infection, including post-stroke immune dysregulation.
- To explore the impact of infections on long-term cognitive and functional outcomes after stroke.
Main Methods:
- Literature review focusing on acute infections (e.g., COVID-19), infectious burden, and post-stroke immune responses.
- Analysis of the interplay between infection, immune system changes, and neurological consequences.
- Conceptual modeling of infection-stroke relationships and their neurological effects.
Main Results:
- Acute infections, such as COVID-19, are identified as stroke triggers.
- Cumulative infections (infectious burden) contribute to long-term atherosclerotic disease and stroke risk.
- Post-stroke immune dysregulation increases the risk of infections and exacerbates cognitive decline, neurodegeneration, and dementia.
Conclusions:
- Infections significantly influence stroke risk and outcomes, both acutely and long-term.
- The bidirectional nature of infection and stroke, coupled with immune dysregulation, poses a substantial threat to neurological health.
- Understanding these complex interactions is crucial for developing strategies to mitigate stroke-associated infections and improve long-term cognitive function.
Abstract:
Understanding the relationship between infection and stroke has taken on new urgency in the era of the coronavirus disease 2019 (COVID-19) pandemic. This association is not a new concept, as several infections have long been recognized to contribute to stroke risk. The association of infection and stroke is also bidirectional. Although infection can lead to stroke, stroke also induces immune suppression which increases risk of infection. Apart from their short-term effects, emerging evidence suggests that poststroke immune changes may also adversely affect long-term cognitive outcomes in patients with stroke, increasing the risk of poststroke neurodegeneration and dementia. Infections at the time of stroke may also increase immune dysregulation after the stroke, further exacerbating the risk of cognitive decline. This review will cover the role of acute infections, including respiratory infections such as COVID-19, as a trigger for stroke; the role of infectious burden, or the cumulative number of infections throughout life, as a contributor to long-term risk of atherosclerotic disease and stroke; immune dysregulation after stroke and its effect on the risk of stroke-associated infection; and the impact of infection at the time of a stroke on the immune reaction to brain injury and subsequent long-term cognitive and functional outcomes. Finally, we will present a model to conceptualize the many relationships among chronic and acute infections and their short- and long-term neurological consequences. This model will suggest several directions for future research.
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