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Updated: Nov 30, 2025
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
COVID-19 Associated Ischemic Stroke and Hemorrhagic Stroke: Incidence, Potential Pathological Mechanism, and
Zilan Wang1, Yanbo Yang1, Xiaolong Liang2
1Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China.
Insights
The novel coronavirus (COVID-19) increases the risk of ischemic and hemorrhagic stroke by inducing inflammation, hypercoagulation, and affecting blood pressure. Management requires adapting traditional guidelines with new clinical insights.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Background:
- The COVID-19 pandemic has seen a rise in neurological complications.
- Cerebrovascular diseases are frequent comorbidities in COVID-19 patients.
- SARS-CoV-2 infection is linked to increased risks of acute ischemic and hemorrhagic stroke.
Purpose of the Study:
- To explore the mechanisms by which SARS-CoV-2 infection contributes to cerebrovascular diseases.
- To highlight the impact of COVID-19 on stroke risk and management.
Main Methods:
- Review of current evidence on COVID-19 and neurological complications.
- Analysis of proposed pathophysiological pathways linking SARS-CoV-2 to stroke.
- Discussion of clinical management strategies.
Main Results:
- Elevated D-dimer levels in COVID-19 patients with ischemic stroke suggest hypercoagulation.
- SARS-CoV-2 binding to ACE2 receptors may increase hemorrhagic stroke risk via blood pressure changes.
- Immune responses, including cytokine storms, contribute to stroke risk.
Conclusions:
- COVID-19 poses a significant threat to cerebrovascular health through multiple mechanisms.
- Stroke management in COVID-19 patients necessitates integrating traditional guidelines with emerging clinical experience and data.
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.
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