Recent studies have demonstrated that experiencing head or neck trauma or minor acute infections such as influenza can increase risk for stroke among adults. Inflammation in the CNS or in the periphery may be a risk factor for the initial development of cerebral ischemia.
Fullerton (University of California, San Francisco, USA) and colleagues hypothesized that trauma and acute infections are independently associated with childhood arterial ischemic stroke (AIS). Researchers carried out a case-control study of 126 children who were admitted to hospital with AIS and 378 age- and primary care facility-matched controls. All the children were selected from a cohort of 2.5 million children and adolescents aged 19 years or younger who were enrolled in the Kaiser Permanente Medical Care Program.
As reported in the Annals of Neurology, the team found that children who had medical treatment for head or neck trauma within the previous 12 weeks had a 7.5-fold increased risk for AIS compared with those who had not.
The median time to stroke following head or neck trauma was short, at a median of 0.5 days, and when trauma exposure was redefined as being within the past week, the increased risk for AIS was much greater, at 39 times the risk among children who had not experienced trauma during this period.
Similarly, seeking treatment for a minor infection such as upper respiratory tract infection, acute otitis media, or acute gastroenteritis within the previous 4 weeks also increased the risk for AIS 4.6-fold compared with having no infection over this time. Overall, 33% of children who had AIS had a history of infection over the previous month compared with 13% of controls.
Atherosclerosis, the pathologic process underlying most coronary artery disease and the majority of ischemic stroke in humans, is an inflammatory process. Inflammatory conditions such as giant cell arteritis and systemic lupus erythematosus predispose to stroke, as do a range of acute and chronic infections, principally respiratory. Previous studies also demonstrated that HIV infection is associated with an increased risk of stroke, particularly cerebral infarction in young patients. This risk is probably mediated by increased susceptibility of HIV-infected patients to meningitis and protein S deficiency. Diverse mechanisms have been proposed to account for inflammation and infection-associated stroke, ranging from classic risk factors to disturbances of the immune and coagulation systems.
Such studies suggest that trauma and acute infection could be used as “targets for primary stroke prevention strategies and considerable opportunities therefore exist for the development of novel therapies.
Hills, N., Johnston, S., Sidney, S., Zielinski, B., & Fullerton, H. (2012). Recent trauma and acute infection as risk factors for childhood arterial ischemic stroke Annals of Neurology, 72 (6), 850-858 DOI: 10.1002/ana.23688
Emsley, H., & Tyrrell, P. (2002). Inflammation and Infection in Clinical Stroke Journal of Cerebral Blood Flow & Metabolism, 1399-1419 DOI: 10.1097/00004647-200212000-00001
Qureshi, A., Janssen, R., Karon, J., Weissman, J., Akbar, M., Safdar, K., & Frankel, M. (1997). Human Immunodeficiency Virus Infection and Stroke in Young Patients Archives of Neurology, 54 (9), 1150-1153 DOI: 10.1001/archneur.1997.00550210078016