Archives of Neurology, Feb 2012

Evidence of intrathecal immunoglobulin synthesis in stroke a cohort study

Pruess H, Iggena D, Baldinger T, Prinz V, Meisel A, Endres M, Dirnagl U, Schwab JM

Background: Immunemechanisms 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.

Design: Retrospective cohort study.

Setting: University hospital neurology department.

Patients: 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.

Conclusion: The strong association between CSFspecific immunoglobulin synthesis and stroke suggests a role in the development of cerebral ischemia and might constitute an immunologically defined stroke subgroup.

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