Pleocytosis in cerebrospinal fluid attributed to ischemic stroke: A review of the literature

Lumbar puncture is generally performed in stroke settings when infectious or inflammatory diseases are suspected to be the etiology. This review aimed to assess the prevalence of pleocytosis in the cerebrospinal fluid following ischemic stroke without inflammatory or infectious etiology. We searched PubMed for studies with mentions of “[ischemic stroke] AND [cerebrospinal fluid]”. We included only studies written in English, including patients with a primary diagnosis of either ischemic stroke or transient ischemic attack (TIA), and where white blood cell count in the spinal fluid was presented. Studies investigating common etiologies for pleocytosis, was excluded. Study and patient characteristics, white blood cell count and time to lumbar puncture were presented in tables, and the prevalence of pleocytosis were reported and plotted graphically. We included 15 studies with 1607 patients, 1522 with ischemic stroke and 85 with TIA. The prevalence of pleocytosis was between 0% to 28,6% and a mean of 11.8%. The highest white blood cell count found with common etiologies for pleocytosis ruled out was 56 cells/mm3. A mean white blood cell count of 4.0 was based on the three studies where this was available. The included studies were methodologically heterogenous and few had pleocytosis as primary outcome. Pleocytosis following ischemic stroke is uncommon and should prompt further investigations •Pleocytosis in cerebrospinal fluid after ischemic stroke is uncommon.•Findings of pleocytosis in CSF after ischemic stroke should lead to further investigations.•Pleocytosis is more common in settings of neuroinflammation or infection.•The studies identified in this review where heterogenous in design.