Evidence of Intrathecal Immunoglobulin Synthesis in Stroke A Cohort Study

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 CSFspecific immunoglobulin synthesis and stroke suggests a role in the development of cerebral ischemia and might constitute an immunologically defined stroke subgroup. Arch Neurol. 2012; 69(6): 714-717. Published online February 27, 2012. doi:10.1001/archneurol.2011.3252