The Role of Infectious Diseases of the Lower Respiratory Tract in the Pathogenesis of Ischemic Stroke

Objective: to clarify the pathogenesis of ischemic stroke in infectious diseases of the lower respiratory tract.

Material and methods. We searched the PubMed database for original research articles, clinical reports, review articles, editorials, commentaries, and short communications published before June 25, 2025. Additional studies that were not captured through the primary database search were analyzed after manually examining the reference lists of the selected articles. Articles were selected based on the relevance of the title and abstract to the purpose of this review. Data from 160 sources were included in the analysis.

Results. We have identified and analyzed in detail the mechanisms of ischemic stroke development in respiratory infections: activation of the coagulation system and disruption of natural anticoagulant and fibrinolytic mechanisms (1); interaction of the hemostasis system with innate immunity (2); the effect of infectious agents on the progression of atherosclerosis and the stability of the atherosclerotic plaque (3); the formation of thromboemboli in the pulmonary veins (4).

Conclusion. Both bacterial and viral infections can initiate a procoagulant state mediated by tissue factor, von Willebrand factor, platelet activation, neutrophil extracellular traps and decreased activity of endogenous anticoagulants. The infectious process localized in the lungs, characterized by damage to the pulmonary vascular endothelium, alveolocytes, intraalveolar fibrin deposition, edema, cellular infiltration, in concert with hemostasis alterations create conditions for the formation of thrombi in the pulmonary vessels. Thus, the pulmonary veins and venules can be a source of cerebral thromboembolism. This mechanism of thromboembolic stroke development largely explains causes of acute cerebrovascular events in patients with lower respiratory tract infection without cardiovascular risk factors. Another mechanism of ischemic stroke is associated with direct or indirect effects of pathogens on the stability of atherosclerotic plaques in cerebral vessels, which, together with systemic procoagulant imbalance, leads to the formation of atherothrombosis. Given the significant pathogenetic relationship between acute infectious lung diseases and cardioembolic and atherothrombotic strokes, clinical alertness regarding acute cerebrovascular events should be included in monitoring and management of such patients.

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