Evidence of Intrathecal Immunoglobulin Synthesis in Stroke

BACKGROUND: Immune mechanisms are included in stroke pathophysiologic factors, but the frequency and role of intrathecal antibodies is unclear and diagnostic tests are not routinely performed on cerebrospinal fluid (CSF). OBJECTIVE: To determine the frequency of intrathecal immunoglobulin synthesis in a well-characterized cohort of patients who experienced “noninflammatory”acute stroke. DESIGN: Retrospective cohort study. SETTING: University hospital neurology department. PATIENTS: Patients (n=318) with stroke who were undergoing lumbar puncture during diagnostic workup and 79 control patients. RESULTS: Cerebrospinal fluid–specific immunoglobulin(IgG, IgM, and IgA) synthesis was significantly(P.001) more frequent after stroke (24.8%) compared with the incidence in age- and sex-matched controls(2.5%). Furthermore, 31.3% of stroke patients demonstrated blood-brain barrier dysfunction and 18.1% displayed pleocytosis. CONCLUSION: The strong association between CSF-specific immunoglobulin synthesis and stroke suggests a role in the development of cerebral ischemia and might constitute an immunologically defined stroke subgroup.