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COVID-19 and Stroke: Incidental, Triggered or Causative

Rohit Bhatia1, M V Padma Srivastava1

  • 1Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

Annals of Indian Academy of Neurology
|July 2, 2020
PubMed

Insights

COVID-19 (coronavirus disease 2019) is linked to serious neurological complications like stroke. Factors such as inflammation, clotting, and potential direct viral effects on the brain may contribute to stroke occurrence in patients with SARS-CoV-2 infection.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiovascular Science

Background:

  • The COVID-19 pandemic, caused by SARS-CoV-2, presents a significant neurological comorbidity in the form of stroke.
  • Stroke manifestations include ischemic stroke, intracerebral hemorrhage, and cerebral venous thrombosis.

Purpose of the Study:

  • To review potential contributing factors for stroke in COVID-19 patients.
  • To explore the interplay between conventional stroke risk factors, infection, inflammation, and plaque destabilization.

Main Methods:

  • Review of literature and observational data on stroke in COVID-19 patients.
  • Analysis of potential pathophysiological mechanisms including inflammatory markers, D-dimer levels, cytokine activity, cardiac injury, prothrombotic state, and neuroinvasion.

Main Results:

  • Elevated inflammatory markers, D-dimer, and cytokine activity are observed in COVID-19 patients.
  • Cardiac injury leading to embolism, a prothrombotic state, and direct neuroinvasive potential causing vasculopathy are probable contributing factors.
  • Interaction between conventional stroke risk factors, infection, systemic inflammation, and plaque destabilization is suggested.

Conclusions:

  • Multiple factors contribute to stroke occurrence in COVID-19 patients.
  • Further research using large multicentric cohorts is needed to elucidate the occurrence, etiology, pathophysiology, biomarkers, and outcomes of pandemic-related strokes.

Keywords:
COVID-19SARSSARS-CoV-2infectionstroke

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