PRECIPITANTS OF BRAIN INFARCTION - ROLES OF PRECEDING INFECTION INFLAMMATION AND RECENT PSYCHOLOGICAL STRESS

Background and Purpose Antecedent febrile infection and psychological stress are described as predisposing risk factors for brain infarction . We examined the temporal relationship between preceding infection/in flammation and stroke onset as well as the role of recent psychologica l stress as a potential precipitant for brain infarction. Methods In t his case-control study, a standardized evaluation including a signs/sy mptoms-based questionnaire was used to characterize the prevalence and timing of recent prior (< 1 month) infectious and inflammatory syndro mes in 37 adults with acute brain infarction, 47 community control sub jects, and 34 hospitalized nonstroke neurological patient controls. Re cent psychological stress was measured with scales of stressful life e vents and negative affect. Results The prevalence of infection/inflamm ation was significantly higher in the stroke group only within the pre ceding 1 week compared with either community control subjects (13/37 v ersus 6/47, P < .02) or hospitalized neurological patient controls (3/ 34, P < .02). Upper respiratory tract infections constituted the most common type of infection. A substantial proportion of stroke patients with preceding (< 1 week) infection/inflammation (5/13) had no accompa nying fever or chills. There were no significant differences between t he stroke and control groups in the levels of stressful life events wi thin the prior 1 month or in neg negative-affect scale scores within t he prior 1 week. Conclusions Our data suggest that both febrile and no nfebrile infectious/inflammatory syndromes may be a common predisposin g risk factor for brain infarction and that the period of increased ri sk is confined within a brief temporal window of less than 1 week. Res ults of this study argue against a role for recent psychological stres s as a precipitant for cerebral infarction.