TNF and infection: While the immune response starts locally, inflammatory mediators propagate, which leads to a systemic inflammatory response, followed by immunosuppression.27 Changes in TNF (tumor necrosis factor) and IL (interleukin)-6 levels have been observed in patients at the onset of stroke.28 This response may be due to a state of immunodepression that occurs poststroke, as there are increased risks of poststroke infections.27 There is increasing evidence that greater inflammation is associated with AIS progression.