Infections causing stroke or stroke-like syndromes
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REVIEW
Infections causing stroke or stroke‑like syndromes Pasquale Pagliano1 · Anna M. Spera1 · Tiziana Ascione2 · Silvano Esposito1 Received: 14 January 2020 / Accepted: 20 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Stroke has relevant morbidity and mortality despite appropriate treatments and early diagnosis. Beside common risk factors such as diabetes and atrial fibrillation, infections can be involved in stroke pathogenesis, probably causing a systemic release of cytokines and other inflammatory mediators, triggering a latent pro-thrombotic state or damaging the vascular endothelium. In other cases, infections can occur as stroke-like syndromes, requiring a high grade of suspicion to avoid a delay in establishing a correct diagnosis. Results Treatment of stroke or stroke-like syndromes of infectious origin can be difficult. When a previous infective event triggers stroke, Alteplase administration can be associated with a higher incidence of bleeding and the extension of the ischaemic area can be major than expected. On the other hand, when stroke is part of some infectious diseases’ presentation as in endocarditis, bacterial or tuberculous meningitis and meningo-vascular syphilis, a correct diagnosis can be difficult. The management of these stroke-like syndromes is not standardised because common treatments proven to be effective for patients with stroke of vascular origin can worsen the prognosis, as it can be demonstrated after to be incorrect Alteplase administration to patients with endocarditis with septic embolism to the brain is associated with an increase of the risk of haemorrhage. Conclusions Stroke or stroke-like syndrome of infectious origin can be observed in an important proportion of case presenting with sensory-motor deficit of unknown origin; their accurate diagnosis has a considerable impact in terms of treatment choices and outcome. Keywords Stroke · Infection · Endocarditis · Influenza · Sepsis · Syphilis · Meningitis
Introduction Stroke is a threatening cause of disability and death; it is estimated that over 42 million cases and over 6 million deaths occurred in 2015 [1]. Currently, intravenous recombinant tissue-type plasminogen activator (r-tPA) and intraarterial thrombectomy are the only treatments with high impact in terms of mortality and stroke-related disability reduction; unfortunately, these treatments cannot be applied to all patients because of the limited temporal window in respect of symptom onset and the relevant side effects of r-tPA. To avoid the high impact of stroke in terms of * Silvano Esposito [email protected] 1
Department of Infectious Diseases, University of Salerno, Salerno, Italy
Department of Infectious Diseases, AORN Dei Colli, Naples, Italy
2
mortality and residual disability, prevention through careful evaluation of risk factors predisposing or triggering brain infarction remains of crucial importance to limit deaths and disability related to stroke; in this way, the role of infections
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