Acute Ischemic Stroke in COVID-19: Putative Mechanisms, Clinical Characteristics, and Management.

Ademola S Ojo,Simon A Balogun,Ahmed O Idowu,Herbert Brok

doi:10.1155/2020/7397480

Abstract

The emergence and spread of the highly contagious novel coronavirus disease (COVID-19) have triggered the greatest public health challenge of the last century. Aside from being a primary respiratory disease, acute ischemic stroke has emerged as a complication of the disease. While current evidence shows COVID-19 could cause ischemic stroke especially in severe disease, there are similarities in the risk factors for severe COVID-19 as well as ischemic stroke, underscoring the complex relationship between these two conditions. The pandemic has created challenges for acute stroke care. Rapid assessment and time-sensitive interventions required for optimum outcomes in acute stroke care have been complicated by COVID-19 due to the need for disease transmission preventive measures. The purpose of this article is to explore the putative mechanisms of ischemic stroke in COVID-19 and the clinical characteristics of COVID-19 patients who develop ischemic stroke. In addition, we discuss the challenges of managing acute ischemic stroke in the setting of COVID-19 and review current management guidelines. We also highlighted potential areas for future research.

Highlights

Academic Editor: Herbert Brok e emergence and spread of the highly contagious novel coronavirus disease (COVID-19) have triggered the greatest public health challenge of the last century
Rapid assessment and time-sensitive interventions required for optimum outcomes in acute stroke care have been complicated by COVID-19 due to the need for disease transmission preventive measures. e purpose of this article is to explore the putative mechanisms of ischemic stroke in COVID-19 and the clinical characteristics of COVID-19 patients who develop ischemic stroke
An observatory study involving 280 centers in China shows hospital admissions for stroke reduced by 40%, while thrombolysis and thrombectomy cases dropped by 25% in February 2020, when compared to February 2019 [39]. is reduction in stroke admissions could be due to patients opting to stay at home out of fear of contracting the virus in the hospital. e overall effect of this is a delayed onset of care, with many patients missing the therapeutic window [3]

Summary

Pathogenesis of Ischemic Stroke in COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is an enveloped, single-stranded, positive-sense RNA virus of the Coronaviridae family and it has a phospholipid bilayer capsule containing spike proteins [7]. APL antibodies are often found in healthy individuals, and elevated levels have been reported in both viral and bacterial infections [14] It is still unclear if the presence of APL antibodies in COVID-19 patients contributes to the coagulopathy or increases the risk of ischemic stroke. A study reported three COVID-19 patients with large-vessel ischemic stroke following subocclusive severe stenosis of the common carotid artery with the thrombosis extending into the proximal internal carotid artery [30]. Another study reported a case of a 40-year-old COVID-19 patient with a negative procoagulant work-up who developed large-vessel ischemic stroke involving the middle cerebral artery [31]. In a study reporting six patients with COVID-19 who developed ischemic stroke, all the patients have large-vessel occlusion with markedly elevated D-dimers. In a retrospective study of six COVID-19 patients with stroke, five died, while one had persistent severe neurological deficit [36]

Challenges of Managing Stroke in the Setting of COVID-19

Management of Acute Ischemic Stroke in COVID-19

Findings

Conclusion and Recommendations for Future Research