Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
Curr Opin Infect Dis. 2019 Jun;32(3):285-292. doi: 10.1097/QCO.0000000000000547.
Stroke continues to be a leading cause of debility in the world. Infections have been associated with stroke, but are not considered as directly causal, and so they are not often included in the traditional stroke workup and management. They are especially important in patients with stroke of undetermined etiology, and in certain patient populations, such as young patients without traditional risk factors, and immunocompromised patients.
There has been strong evidence for infectious conditions, such as endocarditis, and pathogens, such as varicella zoster in stroke causation, and more supportive evidence is surfacing in recent years of several organisms increasing the stroke risk or being directly causal in stroke. The evidence also seems to be pointing to the role of inflammation in increasing the risk of stroke via accelerated atherosclerosis, vasculitis and vasculopathy.
Infectious causes should be considered in the differential and work up of stroke in certain patient populations and appropriate treatments need to be initiated to minimize adverse stroke-related outcomes.
中风仍然是世界范围内导致身体虚弱的主要原因。感染与中风有关,但不被认为是直接的致病因素,因此它们通常不包括在传统的中风检查和治疗中。在病因不明的中风患者以及某些特定人群(如无传统危险因素的年轻患者和免疫功能低下的患者)中,感染尤其重要。
已有强有力的证据表明,感染性疾病(如心内膜炎)和病原体(如水痘带状疱疹病毒)与中风的发病有关,近年来越来越多的证据表明,某些病原体增加了中风风险,或直接导致中风。证据似乎还表明,炎症通过加速动脉粥样硬化、血管炎和血管病变增加中风风险。
在某些特定人群中,应考虑将感染性病因作为中风的鉴别诊断和检查的一部分,并应进行适当的治疗,以最大限度地减少不良的与中风相关的结局。