Recent Infections and Cryptogenic Ischemic Stroke
Recent infection was associated with higher cryptogenic ischemic stroke odds in younger adults and linked biomarker changes.
A multicenter case control study has found that infections in the week before stroke were associated with significantly higher odds of early onset cryptogenic ischemic stroke in adults aged 18–49 years. The analysis included 537 matched pairs of patients with first ever cryptogenic ischemic stroke and stroke free controls.
Overall, infections reported within the previous 3 months were not more common in cases than controls. However, infections occurring within the preceding week were more frequent among cases and were associated with a 2.6 fold increase in the odds of cryptogenic ischemic stroke after adjustment for demographic and vascular risk factors. Infections confirmed by a physician or laboratory testing, as well as nonrespiratory infections, were also associated with higher odds of stroke.
Coagulation Biomarkers in Cryptogenic Ischemic Stroke
The biomarker findings pointed to a possible thromboinflammatory response in patients with recent infection. At baseline, all coagulation biomarkers measured were higher in cases than in controls. Among cases, von Willebrand Factor activity was notably higher in those with a recent infection than in those with remote or no preceding infection. Factor VIII showed a similar pattern, while C reactive protein also appeared to rise in parallel.
In stratified analyses, each standard deviation increase in von Willebrand Factor and factor VIII was associated with higher odds of cryptogenic ischemic stroke in participants with recent infection or fever. These associations were more pronounced in acute and nonrespiratory infections. By contrast, controls did not show similar biomarker differences according to infection status.
Clinical Meaning of the Findings
The authors suggested that young patients with cryptogenic ischemic stroke may have an increased sensitivity to inflammatory triggers, with recent infection potentially amplifying coagulation pathways linked to stroke onset. Importantly, these biomarker elevations were not sustained at 3 month follow up, supporting the possibility of a transient response rather than a persistent abnormality.
While the study cannot establish causality, it strengthens the case for recent infection as a short-term trigger in early onset cryptogenic ischemic stroke. The findings also highlight von Willebrand Factor and factor VIII as potential markers of infection related stroke risk in this younger population.
Reference
Hulsen BM et al. Preceding infections and coagulation biomarkers in early-onset cryptogenic ischemic stroke. Stroke. 2026;DOI:10.1161/STROKEAHA.125.052134.
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