(Stroke. 1997;28:1724-1729.)
© 1997 American Heart Association, Inc.
Articles |
Association Between Acute Cerebrovascular Ischemia and Chronic and Recurrent Infection
From the Department of Neurology (A.J.G., F.B., A.B., W.H.), Department of Oral and Maxillofacial Surgery (C.Z., W.S.), Department of Ear, Nose and Throat Medicine (J.M., A.-J.T.), Department of Neurosurgery (C.B.), University of Heidelberg, and Department of Epidemiology, German Cancer Research Center (H.B.), Heidelberg, Germany.
Correspondence to Armin J Grau, MD, Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. E-mail Armin_Grau{at}krzmail.krz.uni-heidelberg.de
Background and Purpose We performed a case-control study to investigate whether chronic or recurrent respiratory, ear-nose-throat (ENT), and dental infections are risk factors for cerebrovascular ischemia.
Methods Using a standardized questionnaire we investigated past infectious diseases in 166 consecutive patients with acute cerebrovascular ischemia and in 166 age- and sex-matched nonstroke neurological patient controls. In subgroups, we performed standardized ENT (69 patients, 66 control subjects) and dental examinations including orthopantomography (66 patients, 60 control subjects). Dental status was determined by a total dental index (TDI) that reflects caries, periapical lesions, periodontitis, and other dental lesions and by an orthopantomography index (OPGI) that was assessed blinded.
Results Frequent (
2 episodes in each of the 2 preceding
years) or chronic bronchitis was associated with cerebrovascular
ischemia in age-adjusted multiple logistic regression
analysis (odds ratio, OR, 2.2; 95% confidence interval, CI,
1.04 to 4.6). Groups were not different in ENT examination. Patients
tended to have a worse dental status (TDI: P=.070; OPGI:
P=.062) and had more severe periodontitis
(P=.047) and periapical lesions (P=.027) than
control subjects. In age-adjusted multiple logistic regression
analysis with social status and established vascular risk
factors, poor dental status (TDI) was independently associated with
cerebrovascular ischemia (OR, 2.6; 95% CI, 1.18 to 5.7).
Conclusion Recurrent or chronic bronchial infection and poor dental status, mainly resulting from chronic dental infection, may be associated with an increased risk for cerebrovascular ischemia.
Key Words: cerebral ischemia • risk factors • infection
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