COVID-19 Associated Ischemic Stroke and Hemorrhagic Stroke: Incidence, Potential Pathological Mechanism, and Management.

Zilan Wang,Meirong Liu,Zhouqing Chen,Xiaolong Liang,Zhong Wang,Yanbo Yang,Wen Li,Bixi Gao

doi:10.3389/fneur.2020.571996

Abstract

The outbreak of the novel coronavirus infectious disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has rapidly spread around the world. Increasing evidence has suggested that patients with COVID-19 may present neurological symptoms, and cerebrovascular diseases are one of the most frequent comorbidities. The markedly elevated D-dimer levels in patients with acute ischemic stroke suggests that SARS-CoV-2 infection may induce an inflammatory response and trigger a hypercoagulation state, thus leading to acute ischemic stroke. Cardioembolism and atherosclerosis in patients with COVID-19 infection may also increase the risk of ischemic stroke. The reduction of the angiotensin-converting enzyme II (ACE2) caused by SARS-CoV-2 binding to the ACE2 receptor can lead to abnormally elevated blood pressure and increase the risk of hemorrhagic stroke. Additionally, the cytokine storm induced by the immune response against the viral infection increases the risk of acute stroke. The management for COVID-19 patients with stroke is not only based on the traditional guidelines, but also based on the experience and new instructions from healthcare workers worldwide who are combatting COVID-19.

Highlights

As COVID-19 has rapidly spread worldwide, increasing evidence suggests that SARS-CoV-2 may invade the central nervous system and induce neurological symptoms [1,2,3]
COVID-19 and Stroke pandemic have impacted stroke centers and caused a worldwide drop of over 30% in the number of patients with stroke or transient ischemic attacks (TIA) seeking emergency care, which could affect the prognosis in these patients [10, 12,13,14,15]
The results showed that, despite the use of anticoagulant prophylaxis, the rate of venous and arterial thromboembolic complications in hospitalized COVID-19 patients accounts for ∼8% of the included patients [30]

Summary

Introduction

As COVID-19 has rapidly spread worldwide, increasing evidence suggests that SARS-CoV-2 may invade the central nervous system and induce neurological symptoms [1,2,3]. Research from Wuhan reported neurologic manifestations in 36.4% of 214 COVID-19 patients [4]. An increasing number of studies have revealed that in addition to the typical respiratory symptoms such as fever and dry cough, patients with COVID-19 may develop neurological manifestations, ranging from mild to severe [4,5,6,7,8,9]. Previous studies have suggested that cerebrovascular disease is an independent risk factor for severe cases of COVID-19 infection [11]. The risk of cross-infection and lack of experienced stroke care experts during the COVID-19

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Conclusion