COVID-19 and stroke: from the cases to the causes

Area of Science:

• Neurology
• Infectious Diseases
• Vascular Medicine

Background:

• The COVID-19 pandemic has seen various stroke types in SARS-CoV-2 patients.
• Understanding the pathogenic mechanisms of stroke during SARS-CoV-2 infection is crucial.

Purpose of the Study:

• To systematically review case reports of acute stroke in COVID-19 patients.
• To identify and characterize different stroke profiles associated with SARS-CoV-2 infection.
• To elucidate the pathogenic mechanisms underlying these stroke types.

Main Methods:

• Systematic review of 89 studies comprising 168 patients with acute stroke and COVID-19.
• Analysis of demographic data, cerebrovascular risk factors, NIHSS scores, vascular territory, and laboratory findings.
• Categorization of stroke profiles based on clinical and laboratory data.

Main Results:

• Four distinct stroke profiles were identified: cerebral large vessel disease (CLVD) with low disability, intracranial bleeding (IB) with high disability, CLVD with high disability and inflammation, and multiple thrombo-embolic disease (MTED) with comorbidities and high inflammation.
• These profiles were mapped onto a spectrum correlating with inflammation and prothrombotic activity.
• IB and small vessel disease (CSVD) with low inflammation were in the violet-blue band; CLVD with high inflammation was in the green-yellow band; MTED with high inflammation was in the orange-red band.

Conclusions:

• SARS-CoV-2 infection can lead to a spectrum of stroke types.
• Stroke profiles in COVID-19 patients vary in disability, outcome, and association with inflammatory and prothrombotic markers.
• The identified spectrum provides a framework for understanding stroke pathogenesis in the context of COVID-19.