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COVID-19 and stroke: A review

Xiaoming Qi1, Kristin A Keith1,2, Jason H Huang1,2

  • 1Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, USA.

Brain Hemorrhages
|November 23, 2020
PubMed

Insights

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause stroke in patients by inducing coagulopathy and endothelial dysfunction. Further research is needed to understand the mechanisms and develop interventions for COVID-19-related stroke.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Vascular Medicine

Background:

  • COVID-19 is associated with diverse neurological complications.
  • Stroke is a particularly severe neurological outcome observed in COVID-19 patients.
  • Understanding the link between SARS-CoV-2 infection and stroke is critical.

Purpose of the Study:

  • To review current literature on stroke in COVID-19 patients.
  • To elucidate the current understanding of stroke mechanisms in this population.
  • To highlight the impact on healthcare systems and stroke care.

Main Methods:

  • Systematic review of studies, case series, and case reports.
  • Focus on COVID-19 patients with stroke complications.
  • Analysis of laboratory markers indicative of coagulopathy and endothelial dysfunction.

Main Results:

  • SARS-CoV-2 infection leads to coagulopathy, evidenced by elevated D-dimer, fibrinogen, factor VIII, and von Willebrand factor.
  • Endothelial dysfunction and a hypercoagulable state are promoted by the infection.
  • These factors predispose COVID-19 patients to cerebrovascular events like stroke.

Conclusions:

  • COVID-19 infection significantly increases the risk of stroke through mechanisms involving hypercoagulability and endothelial damage.
  • The healthcare system's strain during the pandemic has compromised stroke care.
  • Further investigation into the underlying mechanisms and development of therapeutic strategies for COVID-19-associated stroke are essential.

Keywords:
ACE2, Angiotensin-converting enzyme 2COVID-19COVID-19, Coronavirus disease 2019CPR, C-reactive proteinCVD, Cerebrovascular diseaseCerebrovascular diseasesDIC, Disseminated intravascular coagulationECMO, Extracorporeal membrane oxygenationICH, Intracranial hemorrhageIL-6, Interleukin-6MERS, Middle East Respiratory SyndromeNIHSS, National Institutes of Health Stroke ScalePT, Prothrombin timeSARS-CoV-1, Severe acute respiratory syndrome coronavirus 1SARS-CoV-2SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2StrokeTNF-alpha, Tumor necrosis factor-alphaaPL, AntiphospholipidaPTT, Activated partial thromboplastin timert-PCR, Reverse transcription polymerase chain reactionvWF, Von Willebrand Factor

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