Early recanalization of the occluded vessel is the only efficient intervention that improves outcome after ischemic stroke. In contrast, interventions for chronic issues facing stroke patients are limited. Recent clinical and preclinical studies have shown a correlation between upregulated immune responses to brain antigens and post-stroke recrudescence (PSR), post-stroke fatigue (PSF), and dementia (PSD); all of which are associated with poor long-term stroke outcome. Recent retrospective studies have demonstrated a strong correlation between the onset of PSR and acute infection during acute stroke, suggesting some adaptive immune system mediated pathology. This review will discuss the mechanisms and epidemiology of PSR based on the current clinical and pre-clinical evidence. Accordingly, PSR does appear correlated with populations that are prone to autoimmunity, infection, and subsequent triggers, which corroborate autoimmune responses to self-brain antigens as an underlying mechanism. Moreover, PSR as well as PSF and PSD seem to be partly explained by the development of a neuro-inflammatory response to brain antigens. Therefore, the future of improving long-term stroke outcome could be bright with more accurate pre-clinical models focusing on the role of adaptive immune-mediated post stroke neuroinflammation and more clinical studies of PSR.

中文翻译：

---

中风后复发——可能与自身免疫有关？

闭塞血管的早期再通是改善缺血性卒中后预后的唯一有效干预措施。相比之下，对中风患者面临的慢性问题的干预是有限的。最近的临床和临床前研究表明，对脑抗原的免疫反应上调与中风后复发 (PSR)、中风后疲劳 (PSF) 和痴呆 (PSD) 之间存在相关性。所有这些都与长期中风预后不良有关。最近的回顾性研究表明，急性卒中期间 PSR 的发作与急性感染之间存在很强的相关性，这表明存在一些适应性免疫系统介导的病理学。本综述将根据目前的临床和临床前证据讨论 PSR 的机制和流行病学。因此，PSR 确实似乎与容易发生自身免疫、感染和随后触发的人群相关，这证实了对自身脑抗原的自身免疫反应是一种潜在机制。此外，PSR 以及 PSF 和 PSD 似乎部分可以通过对脑抗原的神经炎症反应的发展来解释。因此，通过更准确的临床前模型，专注于适应性免疫介导的卒中后神经炎症的作用和更多 PSR 的临床研究，改善长期卒中结果的未来可能是光明的。