(Stroke. 1995;26:1393-1398.)
© 1995 American Heart Association, Inc.
Articles |
Early Intrathecal Production of Interleukin-6 Predicts the Size of Brain Lesion in Stroke
From the Departments of Clinical Immunology (E.T., A.T.), Clinical Neurosciences (section of Neurology) (E.T., L.R., C.B., C.W.), Radiology (C.J., S.E.), and Rheumatology (A.T.), University of Göteborg, Sweden.
Correspondence to Dr Elisabeth Tarkowski, Department of Clinical Immunology, Guldhedsgatan 10, S-413 46 Göteborg, Sweden.
Background and Purpose We have previously demonstrated that stroke influences systemic immune responses. The aim of the present study was to investigate patterns of local inflammatory response as a consequence of acute stroke.
Methods Thirty stroke patients were studied prospectively on days 0 to 3, 7 to 9, 21 to 26, and after day 90 with clinical evaluations, radiological assessments, and analysis of serum and cerebrospinal fluid cytokine levels.
Results Significantly increased levels of interleukin-6 (IL-6) in
cerebrospinal fluid (P<.001) were observed in virtually all
patients studied compared with healthy control subjects. This increase
was observed during the whole observation period but was significantly
more pronounced within the first days after stroke onset, with a peak
level on days 2 and 3. This initial increase was significantly
correlated (r=.65, P=.002) with the volume of
infarct measured by MRI 2 to 3 months later. Serum levels of IL-6 in
stroke patients were significantly lower than cerebrospinal fluid
levels of IL-6 (P=.013) and did not display any significant
correlation to the size of the brain lesion. Also, increase in
intrathecal but not systemic production of IL-1ß
was observed early during the stroke. Only minor increases of
cerebrospinal fluid interferon-
levels were observed in two
patients.
Conclusions Our study demonstrates an intrathecal production of IL-6 and IL-1ß in patients with stroke, supporting the notion of localized inflammatory response to acute brain lesion. In addition, the significant correlation between early intrathecal production of IL-6 and the subsequent size of the brain lesion can be used as a prognostic tool, predicting the size of the brain damage before it is possible to accurately visualize it with radiological methods.
Key Words: cerebrospinal fluid • magnetic resonance imaging • interleukins • prognosis
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