title: Association between acute cerebrovascular ischemia and chronic and recurrent infection.
abstract: OBJECTIVE
  We performed a case-control study to investigate whether chronic or recurrent respiratory, ear-nose-throat (ENT), and dental infections are risk factors for cerebrovascular ischemia.
  
  
  METHODS
  Using a standardized questionnaire we investigated past infectious diseases in 166 consecutive patients with acute cerebrovascular ischemia and in 166 age- and sex-matched nonstroke neurological patient controls. In subgroups, we performed standardized ENT (69 patients, 66 control subjects) and dental examinations including orthopantomography (66 patients, 60 control subjects). Dental status was determined by a total dental index (TDI) that reflects caries, periapical lesions, periodontitis, and other dental lesions and by an orthopantomography index (OPGI) that was assessed blinded.
  
  
  RESULTS
  Frequent (> or = 2 episodes in each of the 2 preceding years) or chronic bronchitis was associated with cerebrovascular ischemia in age-adjusted multiple logistic regression analysis (odds ratio, OR, 2.2; 95% confidence interval, CI, 1.04 to 4.6). Groups were not different in ENT examination. Patients tended to have a worse dental status (TDI: P = .070; OPGI: P = .062) and had more severe periodontitis (P = .047) and periapical lesions (P = .027) than control subjects. In age-adjusted multiple logistic regression analysis with social status and established vascular risk factors, poor dental status (TDI) was independently associated with cerebrovascular ischemia (OR, 2.6; 95% CI, 1.18 to 5.7).
  
  
  CONCLUSIONS
  Recurrent or chronic bronchial infection and poor dental status, mainly resulting from chronic dental infection, may be associated with an increased risk for cerebrovascular ischemia.
authors.affiliation: Department of Neurology, University of Heidelberg, Germany. ArminvGrau@krzmail.krz.uni-heidelberg.de
authors.forename: A J
authors.initials: AJ
authors.lastname: Grau
authors.forename: F
authors.initials: F
authors.lastname: Buggle
authors.forename: C
authors.initials: C
authors.lastname: Ziegler
authors.forename: W
authors.initials: W
authors.lastname: Schwarz
authors.forename: J
authors.initials: J
authors.lastname: Meuser
authors.forename: A J
authors.initials: AJ
authors.lastname: Tasman
authors.forename: A
authors.initials: A
authors.lastname: Bühler
authors.forename: C
authors.initials: C
authors.lastname: Benesch
authors.forename: H
authors.initials: H
authors.lastname: Becher
authors.forename: W
authors.initials: W
authors.lastname: Hacke
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D001991:Bronchitis; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007239:Infections; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases; D010038:Otorhinolaryngologic Diseases; D011862:Radiography, Panoramic; D012008:Recurrence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014070:Tooth