title: Systemic infection and inflammation as trigger factors of ischemic stroke.
abstract: BACKGROUND
  Chronic risk factors are well understood in cases of stroke as well as myocardial infarction. Till date, several triggers for stroke are still under evaluation. Researchers have previously evaluated the relationship between preceding infection and inflammation and stroke onset.
  
  
  OBJECTIVE
  The purpose of study is to define the stroke triggers in a better way and to provide little more information for early intervention by controlling infections or other trigger factors.
  
  
  METHODS
  In this retrospective study, a standardized questionnaire was carried out to evaluate the signs, symptoms of preceding (<14 days) infection, physical/mental health, drug history, TIA etc. of 70 ischemic stroke patients and 80 non-stroke out-patient department patients as control groups. Important biochemical tests e.g. high sensitivity CRP, leukocytes count, blood sugar, lipid profile, etc. were also taken into consideration. Recent (15 days) prior infection, mainly respiratory tract infection and urinary tract infection, which were likely to be important stroke triggers, were compared between the ischemic stroke groups and the non-stroke patients (control group).
  
  
  RESULTS
  It was found that respiratory tract infection is the most common type of infection (48.5%) compared with the non-stroke control group (30%). Apart from this, there were clinical evidence of infections like gastroenteritis, RTI, UTI etc which were biochemically established by leukocytosis and increased high-sensitivity C-Reactive Protein levels, well-known early diagnostic tools that have good predictive value. This study reveals that well-controlled diabetic, hypertensive or non-diabetic normotensive patients can suddenly develop ischemic stroke following recent infection as evidenced by clinical features, increased levels of high-sensitivity CRP and leukocytosis.
  
  
  CONCLUSIONS
  These diagnostic tools implicate the value of early treatment of febrile illness and introduction or adjustment of doses of antiplatelet agents, antibiotics, etc. to reduce the actual stroke incidence, though it needs multicentre large community based prospective trials to evaluate stroke prone state and effective preventive measures tools at the same time.
authors.affiliation: Department of Medicine and.
authors.forename: Sukdeb
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Neurology, Calcutta National Medical College (CNMC), Kolkata 700 014, West Bengal, INDIA.
authors.forename: Kartick Chandra
authors.initials: KC
authors.lastname: Ghosh
authors.affiliation: Department of Medicine and.
authors.forename: Satyabrata
authors.initials: S
authors.lastname: Pulai
authors.affiliation: Department of Medicine and.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Pulai
authors.affiliation: Department of Medicine and.
authors.forename: Debarati
authors.initials: D
authors.lastname: Bhar
authors.affiliation: Department of Neurology, Calcutta National Medical College (CNMC), Kolkata 700 014, West Bengal, INDIA.
authors.forename: Prasanta Kumar
authors.initials: PK
authors.lastname: Gangopadhyay
keywords: Cerebral infarction; High sensitivity CRP; Infection; Risk factors; Stroke triggers