Infection as a Stroke Risk Factor and Determinant of Outcome after Stroke

Research output: Contribution to journalArticlepeer-review

  • Authors:
  • Mitchell S V Elkind
  • Amelia K Boehme
  • Craig Smith
  • Andreas Meisel
  • Marion S. Buckwalter


Understanding the relationship between infection and stroke has taken on new urgency in the era of the coronavirus disease 19 (COVID-19) pandemic. This association is not a new concept, as several infections have long been recognized to contribute to stroke risk. The association of infection and stroke is also bidirectional. While infection can lead to stroke, stroke also induces immune suppression which increases risk of infection. Apart from their short-term effects, emerging evidence suggests that post-stroke immune changes may also adversely affect long-term cognitive outcomes in stroke patients, increasing the risk of post-stroke neurodegeneration and dementia. Infections at the time of stroke may also increase immune dysregulation after the stroke, further exacerbating the risk of cognitive decline. This review will cover the role of acute infections, including respiratory infections such as COVID-19, as a trigger for stroke; the role of infectious burden, or the cumulative number of infections throughout life, as a contributor to long-term risk of atherosclerotic disease and stroke; immune dysregulation after stroke and its effect on the risk of stroke-associated infection; and the impact of infection at the time of a stroke on the immune reaction to brain injury and subsequent long-term cognitive and functional outcomes. Finally, we will present a model to conceptualize the many relationships among chronic and acute infections and their short- and long-term neurological consequences. This model will suggest several directions for future research.

Bibliographical metadata

Original languageEnglish
JournalStroke; a journal of cerebral circulation
Publication statusAccepted/In press - 17 Aug 2020