Abstract
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.
Funding source: National Institute of Neurological Disorders and Stroke doi.org/10.13039/100000065
Award Identifier / Grant number: R21NS099606
Award Identifier / Grant number: R01NS109174
Funding source: American Heart Association
Award Identifier / Grant number: 17GRNT33670058
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Author contributions: YA, KAH, and HJC were involved in the research and writing of this article.
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Research funding: This work was supported by the National Institute of Neurological Disorders and Stroke grants (R21NS099606 and R01NS109174) and the American Heart Association Grant in Aid (17GRNT33670058) awarded to K.A.H.
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Conflict of interest statement: The authors declare no conflicts of interest.
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