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Armin J. Grau, MD; Tobias Brandt, MD; Florian Buggle, MD; Erdem Orberk, MD; Joannis Mytilineos, MD; Egon Werle, MD; Christian Conradt, PhD; Martin Krause, MD; Ralph Winter, MD; Werner Hacke, MD

Arch Neurol. 1999;56:851-856.

Background  Cervical artery dissection (CAD) is an important cause of ischemic stroke in younger patients. However, its cause is insufficiently understood.

Objective  To test the hypothesis that CAD is frequently associated with recent infection.

Subjects and Methods  We compared the prevalence of infection during the preceding week in 43 consecutive patients with acute CAD and 58 consecutive patients younger than 50 years with acute cerebral ischemia from other causes (control patients). In subgroups of patients, we correlated infectious status with electron microscopic studies of skin biopsy specimens and investigated pathways potentially linking infection and CAD.

Results  Recent infection was more common in patients with CAD (25/43 [58.1%]) than in control patients (19/58 [32.8%]; P=.01). Respiratory tract infection was preponderant in both groups. Recent infection, but not the mechanical factors cough, sneezing, or vomiting, was independently associated with CAD in multivariate analysis. Investigation of serum antibodies against Chlamydia pneumoniae, smooth muscle cells, endothelial cells, collagen types I through IV, and heat shock protein 65 and assessment of serum ₁-antitrypsin and HLA did not contribute to the understanding of the pathogenesis of CAD. More patients with pathologic findings in skin biopsy specimens tended to have had a recent infection (13/21 [62%]) than patients without pathologic findings (2/9 [22%]; P=.11).

Conclusion  Our results suggest a significant association between recent infection and CAD that is not explained by mechanical factors occurring during infection.

From the Departments of Neurology (Drs Grau, Brandt, Buggle, Orberk, Krause, Winter, and Hacke), Immunology (Dr Mytilineos), Medicine (Dr Werle), and Biomedical Statistics (Dr Conradt), University of Heidelberg, Heidelberg, Germany.

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