Is Infection a Cause of Worsening Stroke?
The proportion of patients experiencing infections is higher in patients with severe stroke29,33,26 unlike other stroke complications such as falls, depression or pain.23 Infections can facilitate electrolytic unbalance, hypoxia, and fever, which could theoretically impair neuronal survival within the ischemic penumbra.34 Fever may increase the cerebral metabolic demands,35 change the blood-brain barrier permeability, and promote acidosis and release of excitatory amino acids.36 Entry of bacteria and lypopolisaccharide into the bloodstream also favors thrombosis through tumor necrosis factor (TNF)-α release,37 activation of the tissue factor–mediated extrinsic pathway of blood coagulation,38 reduction of thrombomodulin (anticoagulant), and inhibition of the fibrinolytic system.39 With few exceptions,40 subfebrile temperatures (37.5°C to 39°C) and fever (>39°C) during the first days of stroke are associated with larger infarct volumes, higher mortality, and poorer functional outcome.41,
