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Fatigue after stroke

PJ Tyrrell and DG Smithard

Fatigue is a common symptom after stroke. It is not invariably related to stroke severity and can occur in the absence of depression. It is one of the most troublesome symptoms for many patients and yet nothing is known of its causation. There are no specific treatments. This article assesses the available literature in the context of what is known about fatigue in other disorders. Post-stroke fatigue may be a manifestation of sickness behavior, mediated through the central effects of the cytokine interleukin-1, perhaps via effects on glutamate neurotransmission. Possible therapeutic strategies are discussed which might be a logical basis from which to plan randomized control trials.