LATERALIZATION OF T-LYMPHOCYTE RESPONSES IN PATIENTS WITH STROKE - EFFECT OF SYMPATHETIC DYSFUNCTION

Background and Purpose A number of clinical observations indicate that stroke affects the course of immune-mediated diseases by lateralizati on of the disease manifestations, such as arthritis. The purpose of th is study was to assess the impact of early stroke on lateralization of immune responsiveness. Methods The delayed-type hypersensitivity (DTH ) reaction to purified protein derivative was used as an in vivo measu re of antigen-specific T-lymphocyte reactivity. Assessment of axon ref lex vasodilatation was simultaneously used to test for cutaneous sympa thetic activity. Results There were no significant differences with re gard to lateratization of DTH reactivity when all stroke patients were tested. However, patients with minor stroke displayed a significant ( P<.001) decrease of DTH reaction on the paretic side compared with the contralateral side. In contrast, patients with major stroke showed a significant increase (P=.022) of DTH reaction on the paretic side. Pat ients with left hemiparesis had a significantly greater (P=.045) DTH r esponse on the affected side than patients with a right hemiparesis. I n addition, only the patients with motor deficit but not with sensory deficit or aphasia displayed side differences in DTH responses. When e lectrically evoked axon reflexes were studied in relation to DTH react ions, a significant correlation (r=.64; P<.001) was found between side asymmetries of DTH responses and side asymmetries of axon reflexes in an innervated skin area. No similar relation was present in skin area s where cutaneous sympathetic activity had been blocked by regional an esthesia. Conclusions Early stroke lateralizes T-cell-mediated cutaneo us inflammation. This effect depends on (1) the localization of the br ain lesion, (2) the clinical course of the disease, and (3) the presen ce of motor deficit and may be mediated by (4) alteration of the cutan eous sympathetic nerve traffic.