title: Evidence of intrathecal immunoglobulin synthesis in stroke: a cohort study.
abstract: BACKGROUND
  Immune mechanisms are included in stroke pathophysiologic factors, but the frequency and role of intrathecal antibodies is unclear and diagnostic tests are not routinely performed on cerebrospinal fluid (CSF).
  
  
  OBJECTIVE
  To determine the frequency of intrathecal immunoglobulin synthesis in a well-characterized cohort of patients who experienced “noninflammatory”acute stroke.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University hospital neurology department.
  
  
  METHODS
  Patients (n=318) with stroke who were undergoing lumbar puncture during diagnostic workup and 79 control patients.
  
  
  RESULTS
  Cerebrospinal fluid–specific immunoglobulin(IgG, IgM, and IgA) synthesis was significantly(P.001) more frequent after stroke (24.8%) compared with the incidence in age- and sex-matched controls(2.5%). Furthermore, 31.3% of stroke patients demonstrated blood-brain barrier dysfunction and 18.1% displayed pleocytosis.
  
  
  CONCLUSIONS
  The strong association between CSF-specific immunoglobulin synthesis and stroke suggests a role in the development of cerebral ischemia and might constitute an immunologically defined stroke subgroup.
authors.affiliation: Department of Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. harald.pruess@charite.de
authors.forename: Harald
authors.initials: H
authors.lastname: Prüss
authors.forename: Deetje
authors.initials: D
authors.lastname: Iggena
authors.forename: Tina
authors.initials: T
authors.lastname: Baldinger
authors.forename: Vincent
authors.initials: V
authors.lastname: Prinz
authors.forename: Andreas
authors.initials: A
authors.lastname: Meisel
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Ulrich
authors.initials: U
authors.lastname: Dirnagl
authors.forename: Jan M
authors.initials: JM
authors.lastname: Schwab
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000096:biosynthesis / Q000134:cerebrospinal fluid*; D008297:Male; D008875:Middle Aged; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid; D012189:Retrospective Studies; D013129:Spinal Puncture; D018709:Statistics, Nonparametric; D020521:Stroke / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D013997:Time Factors
chemical_list: D007136:Immunoglobulins; D043025:Oligoclonal Bands