Infections and stroke: from trigger mechanisms to prevention strategies

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Abstract

Background: The problem of acute cerebrovascular accidents associated with infectious diseases is particularly pressing. Long-term risk factors (RFs) for stroke, such as arterial hypertension, diabetes, and atherosclerosis, are of particular importance. Infectious agents act as triggers for acute vascular accidents through mechanisms of systemic inflammation, endothelial dysfunction, and hypercoagulability.

Objective: Analysis of clinical cases of infectious diseases complicated by stroke, assessment of risk factors, inflammatory markers, and hemostasis.

Materials and methods: A single-center retrospective observational study was conducted, including 26 patients with verified stroke secondary to acute infectious pathology. An analysis of stroke types, demographic indicators, comorbid background, etiologic structure of infections, laboratory parameters of inflammation and hemostasis is presented.

Results: Long-term risk factors were identified in 25 patients (96%). Stroke triggers included COVID-19, influenza, hemorrhagic fever with renal syndrome, viral-bacterial infections, and sepsis. Death occurred in 10 patients (38%) (COVID-19 – 50%, influenza – 20%). A comparison of the groups of deceased and surviving patients indicates the severity of inflammation (an increase in C-reactive protein above 100 mg/L in both groups) and hemostatic disorders: D-dimer levels in the deceased group were 5 times higher than in the surviving group (p=0.002).

Discussion: The obtained data confirm the significant role of infectious diseases as a trigger for stroke. Stroke was most frequently associated with COVID-19, but influenza, hemorrhagic fever with renal syndrome, sepsis, and viral-bacterial pneumonia also contributed significantly. High levels of C-reactive protein and D-dimer reflect the severity of systemic inflammation and hemostatic disorders, and a marked increase in D-dimer can be considered an unfavorable prognostic sign.

Conclusion: Infections may be a key risk factor for stroke. Identification and monitoring of long-term stroke risk factors and laboratory markers of inflammation and hemostasis in patients with infectious diseases are essential. Prevention of infection-associated strokes includes vaccination, treatment of chronic infections, and timely administration of anticoagulant therapy when indicated in at-risk patients. A D-dimer level >1000 ng/mL has been proposed as a potential prognostic marker of adverse outcome, which requires further validation.

About the authors

Irina E. Kravchenko

Kazan State Medical University

Author for correspondence.
Email: kravchencoie@mail.ru
ORCID iD: 0000-0003-4408-7542
SPIN-code: 2831-7593

Dr. Sci. (Med.), Professor, Department of Infectious Diseases

Russian Federation, Kazan

Yulia S. Maksimova

Kazan State Medical University

Email: julia_mx@bk.ru
ORCID iD: 0009-0007-6775-3241

Resident, Department of Infectious Diseases

Russian Federation, Kazan

Aleksandr Y. Kazantsev

Kazan State Medical University

Email: engine90@bk.ru
ORCID iD: 0000-0001-9800-9940

Cand. Sci. (Med.), Assistant Professor, Department of Neurology

Russian Federation, Kazan

Bulat S. Fatkullin

Republican Clinical Infectious Diseases Hospital named after Professor A.F. Agafonov

Email: fatkullin_bulat@inbox.ru
ORCID iD: 0009-0004-3505-2166

Cand. Sci. (Med.), Head of the Intensive Care Unit No. 1

Russian Federation, Kazan

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