03 February 2026 : Review article
Neuroimmune Mechanisms and Emerging Intervention Strategies for Post-Stroke Fatigue: A Narrative Review
Zekai Hu
ABCDEF 1, Qingui Sun F 2, Xieyun Jin BCD 3, Jie Zhuang BCD 1, Jun Hu AG 1*
DOI: 10.12659/MSM.951361
Med Sci Monit 2026; 32:e951361
Table 1 Neuroimmune mechanisms in post-stroke fatigue.
| Mechanism | Associated factors | Evidence level | Association with PSF |
|---|---|---|---|
| Cytokine-mediated inflammation | Interleukin-6, tumor necrosis factor-α, interleukin-1β | Moderate to high | Strong association with fatigue levels and inflammation in PSF |
| Neurotransmitter imbalance | Dopamine, serotonin, norepinephrine | Moderate | Disruption linked to mood regulation, energy, and fatigue |
| HPA axis dysregulation | Cortisol levels, stress response | Moderate | Elevated cortisol linked to fatigue persistence post-stroke |
| Neuroplasticity impairment | Altered synaptic plasticity (LTP, LTD), microglial activation | Moderate | Impaired neuroplasticity contributes to cognitive and physical fatigue |
| HPA – hypothalamic-pituitary-adrenal; LTD – long-term depression; LTP – long-term potentiation; PSF – post-stroke fatigue. | |||