Infectious causes of acute ischemic stroke: pathomechanisms and distribution of brain infarct

Infectious diseases and stroke are common and a great health problem worldwide. However, relatively few studies have focused on direct infectious causes of acute stroke, and the exact mechanisms of acute stroke associated with infections are poorly understood. Herein, we present several infectious organisms that are probable causes of stroke. Different pathomechanisms of stroke and neuroimaging features of infection by these organisms are discussed. Specifically, the distribution of cerebral infarction suggests that infections could be a direct cause of acute stroke. These include cerebral convexity probably due to vasculitis in bacterial meningitis, deep infarcts due to endarteritis and inflammation in neurocysticercosis, and exudates in tuberculous meningitis, as well as hemodynamic borderzone infarct due to large vessel vasculitis by direct invasion of fungal infection. We suggest that prompt and appropriate control of these organisms could prevent ischemic stroke.