Assessment of relations between clinical outcome of ischemic stroke and activity of inflammatory processes in the acute phase based on examination of selected parameters.
OBJECTIVE
Inflammatory factors play an important role in the pathogenesis of ischemic stroke. They may influence circulation during the acute phase of stroke and enhance the ischemic region.


METHODS
We examined 51 patients--36 patients in the early stage of stroke, i.e. the first 24 h after onset. Of these, 15 patients had infection and 21 had no infection during the week preceding stroke. There were 15 patients with noninflammatory diseases in the control group. We analyzed parameters of inflammation such as: activity of serum chitotriosidase by fluorimetric assay, C-reactive proteins (CRP), number of white body cells (WBCs), IgG and fibrinogen. We also assessed the neurological stage according to the Scandinavian Stroke Scale (SSS).


RESULTS
In our study, we observed a statistically significant difference (p < 0.05) in the activity of most parameters of inflammation. This difference could be seen in the levels of CRP, number of WBCs and the activity of chitotriosidase, apart from IgG and fibrinogen, between the control group and groups with versus without infection. A significantly increased level of CRP (p < 0.0005) and fibrinogen (p > 0.01) was found on the first day in the stroke group as compared to the control group. The neurological stage on day 4 after stroke, assessed according to the SSS, was significantly worse in the group of patients with infection before stroke than in stroke patients without infection (p < 0.008).


CONCLUSIONS
These results suggest the importance of active inflammatory processes in the pathogenesis of stroke. We observed increased activity of chitotioridase, a parameter of the inflammatory process, in stroke. This study is one more proof that inflammatory processes caused by infection may influence the occurrence of stroke and worsen its outcome. It could be another step towards understanding immunological processes during the acute phase of stroke. The study may also help establish new diagnostic and therapeutic strategies and could be a useful tool for prophylaxis.
Palasik
W
W
Department of Neurology and Epileptology, Center for Medical Postgraduate Education, Institute of Psychiatry and Neurology, Warsaw, Poland. witpal2@wp.pl
Fiszer
U
U
Lechowicz
W
W
Czartoryska
B
B
Krzesiewicz
M
M
Lugowska
A
A
D000209:Acute-Phase Proteins / Q000032:analysis / Q000378:metabolism*; D000210:Acute-Phase Reaction; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007249:Inflammation / Q000097:blood / Q000209:etiology; D007958:Leukocyte Count / Q000379:methods; D007962:Leukocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood* / Q000150:complications / Q000378:metabolism; D013997:Time Factors; D014312:Trisaccharides / Q000097:blood
D000209:Acute-Phase Proteins; D007074:Immunoglobulin G; D014312:Trisaccharides; C041161:chitotriose; D005340:Fibrinogen; D002097:C-Reactive Protein