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Published on: November 10, 2023
Stroke in patients infected by the novel coronavirus and its causal mechanisms: A narrative review
Roberta Marina Ferreira de Oliveira1, Pedro Henrique Chaves de Souza Aguiar1, Raphael Wellerson Rodrigues Mayrink de Paula1
1Faculty of Medicine Federal University of Juiz de Fora (UFJF) Juiz de Fora Minas Gerais Brazil.
Insights
The novel coronavirus (COVID-19) increases stroke risk through various mechanisms. Emergency physicians must screen for stroke in COVID-19 patients to improve outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic has been associated with an increased incidence of cerebrovascular events.
- Understanding the link between SARS-CoV-2 infection and stroke is crucial for patient management.
Purpose of the Study:
- To evaluate stroke development mechanisms during the COVID-19 pandemic.
- To analyze stroke characteristics, including etiology, demographics, comorbidities, and prognosis in COVID-19 patients.
Main Methods:
- A narrative review of studies published between December 1, 2019, and April 28, 2020.
- Keywords: "novel coronavirus" AND "stroke".
- Databases searched: PubMed, Science Direct, Google Scholar, Lilacs, and BVS.
Main Results:
- 22 articles were included, revealing that SARS-CoV-2 infection elevates stroke risk.
- Mechanisms include ACE2 involvement, viral invasion, hypoxia, elevated D-dimer, and reduced platelets.
- Stroke occurred in elderly with comorbidities and in young individuals without risk factors; COVID-19-related stroke is associated with a worse prognosis.
Conclusions:
- Stroke in the context of COVID-19 is multifactorial, involving ischemic, hemorrhagic, and thromboembolic etiologies.
- Emergency physicians require systematic screening, accurate diagnosis, and prompt intervention strategies.
- Early decision-making can mitigate damage and improve survival rates for COVID-19 patients experiencing stroke.
Objective:
The current study aimed to evaluate the mechanisms of stroke development during the coronavirus disease 2019 (COVID-19) pandemic and analyze the related characteristics, such as etiology, age group, associated comorbidities, and prognosis.
Methods:
A narrative was performed using the descriptors ["novel coronavirus"] AND ["stroke"] in the PubMed, Science Direct, Google Scholar, Lilacs, and Biblioteca Virtual em Saúde (BVS) databases, including studies published between December 1, 2019, and April 28, 2020.
Results:
A total of 142 articles were identified, with 89 of them in the PubMed database, 46 in Science Direct, and 7 in Google Scholar. No articles were found using the defined keywords in the Lilacs and BVS databases. A total of 22 articles were included for final evaluation. We observed that infection by the novel coronavirus caused a greater risk of the occurrence of stroke, with several studies suggesting etiological mechanisms, such as the involvement of angiotensin-converting enzyme 2, viral invasion, and hypoxia as well as the increase in D-dimer and the reduction in platelets, which had been commonly observed in COVID-19 cases. The most common complication of stroke was found among the elderly with preexisting comorbidities, mainly cardiovascular disease. We detected reports of strokes among young people with no preexisting risk factors for thromboembolic events, in which the mechanism related to the viral infection was the most probable cause. In this review, we confirmed that stroke is part of the spectrum of clinical manifestations resulting from COVID-19 and is associated with a worse prognosis. Cerebrovascular lesions resulting from complications of the infection by the novel coronavirus occurred as a result of ischemic, hemorrhagic, and/or thromboembolic etiologies.
Conclusion:
The occurrence of stroke during the pandemic as a result of the novel coronavirus has a multifactorial character, and emergency physicians should focus on systematic measures for its screening and accurate diagnosis as well as on appropriate interventions based on early decisionmaking that may have a favorable impact on reducing damage and saving lives.
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