Stroke Treatment in the Setting of Systemic Disease

Abstract: While the possible stroke risks for more prevalent conditions, such as cardiac disease or cancer, are important to recognize, there are other equally devastating systemic diseases that can affect younger adults and, if not cautious, may be misdiagnosed if stroke is the initial presentation. Purpose of review: We aim to discuss treatments of three rarer, but important systemic diseases associated with an increased incidence of ischemic stroke, specifically sickle cell anemia, human immunodeficiency virus (HIV), and Takayasu’s arteritis. Recent findings: Given that individuals with these diseases are now living longer, there is increasingly a two-pronged approach to therapy in order to both (1) control the underlying disease process and (2) address traditional stroke-risk factors. Summary: Ischemic stroke in a patient with HIV may be due to accelerated atherosclerosis, tobacco abuse, or other traditional stroke-risk factors. Therefore, stroke prevention and management are similar to that of the general population. Stroke in HIV can be due to opportunistic infections, in which case the underlying infection should be treated aggressively. For patients with sickle cell anemia, the focus of treatment is on decreasing HbS to prevent further stroke. Patients with Takayasu’s arteritis are treated with immunosuppression to decrease inflammation and prevent stroke.