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Systemic inflammation and cerebrovascular injury in acute stroke

Tuna Demirbas1, Neslin Sahin1, Fatih Turkmen1

  • 1University of Health Sciences, Istanbul Gaziosmanpasa Training and Research Hospital, Department of Radiology - Istanbul, Türkiye.

Revista Da Associacao Medica Brasileira (1992)
|August 12, 2026
PubMed

Insights

The neutrophil-to-lymphocyte ratio is linked to both small vessel disease and arterial calcification in stroke patients, suggesting inflammation drives cerebrovascular injury. This ratio may help assess overall cerebrovascular disease burden.

Area of Science:

  • Neurology
  • Cardiovascular Research
  • Inflammation Studies

Background:

  • Systemic inflammation is implicated in cerebrovascular injury.
  • Cerebral small vessel disease and intracranial arterial calcification are often assessed independently.
  • Understanding their combined burden is crucial for acute ischemic stroke management.

Purpose of the Study:

  • To investigate the association between systemic inflammatory indices and the combined burden of small vessel disease and intracranial arterial calcification.
  • To determine if inflammatory markers can predict global cerebrovascular disease severity in acute ischemic stroke patients.

Main Methods:

  • Retrospective study of 166 acute ischemic stroke patients.
  • Assessment of small vessel disease (white matter hyperintensities, lacunes, microbleeds, enlarged perivascular spaces) via MRI.
  • Evaluation of intracranial arterial calcification severity using CT.
  • Calculation of inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR) and systemic inflammatory response index (SIRI).
  • Multivariate regression analyses to identify independent predictors.

Main Results:

  • Neutrophil-to-lymphocyte ratio (NLR) independently predicted total small vessel disease burden (β=0.39, p=0.026) and intracranial arterial calcification severity (β=0.181, p=0.030).
  • SIRI was not a significant predictor after adjustment.
  • NLR was also associated with cerebral microbleeds and hypertension.
  • Platelet indices correlated with infarct size and enlarged perivascular spaces.

Conclusions:

  • Neutrophil-to-lymphocyte ratio (NLR) is independently associated with both microvascular and macrovascular cerebrovascular injury.
  • Findings support an inflammation-driven continuum in cerebrovascular disease.
  • NLR may serve as a practical biomarker for assessing global cerebrovascular disease burden in acute ischemic stroke.
Abstract

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