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Updated: Nov 17, 2025
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
COVID-19 Pathophysiology Predicts That Ischemic Stroke Occurrence Is an Expectation, Not an Exception-A Systematic
Tissa Wijeratne1,2,3, Sheila Gillard Crewther1,2, Carmela Sales2,3
1School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
Insights
Severe COVID-19 can cause neurological issues like ischemic stroke due to immune responses. Understanding these links is crucial for neurorehabilitation and future treatments.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Increasing clinical reports link severe COVID-19 to diverse neurological manifestations, including acute ischemic stroke (AIS).
- Limited research explores the impact of immunological responses, hypoxia, oxidative stress, and platelet aggregation on the brain in COVID-19.
- COVID-19 and AIS share common biological pathways, necessitating a deeper understanding of their interplay.
Approach:
- This scoping review examines the pathophysiological mechanisms of peripheral and central inflammation leading to COVID-19-related ischemic strokes.
- It highlights shared biological processes between AIS and COVID-19 infection.
- The review emphasizes the impact of neurological impairments and chronic inflammation (post-COVID-19 neurological syndrome) on neurorehabilitation.
Key Points:
- The immunological contribution to COVID-19 pathophysiology predicts neurological sequelae, particularly ischemic stroke.
- COVID-19-related ischemic strokes are becoming more common, posing challenges for neurorehabilitation.
- Shared mechanisms between COVID-19 and AIS underscore the immune system's role in neurological complications.
Conclusions:
- Immune responses in COVID-19 are a significant driver of neurological complications, especially ischemic stroke.
- Effective neurorehabilitation strategies require understanding the pathobiology of COVID-19-related neurological conditions.
- Global collaboration is needed to develop new treatments for COVID-19-associated neurological sequelae and post-COVID-19 neurological syndrome.
Abstract:
Clinical reports of neurological manifestations associated with severe coronavirus disease 2019 (COVID-19), such as acute ischemic stroke (AIS), encephalopathy, seizures, headaches, acute necrotizing encephalitis, cerebral microbleeds, posterior reversible leukoencephalopathy syndrome, hemophagocytic lymphohistiocytosis, peripheral neuropathy, cranial nerve palsies, transverse myelitis, and demyelinating disorders, are increasing rapidly. However, there are comparatively few studies investigating the potential impact of immunological responses secondary to hypoxia, oxidative stress, and excessive platelet-induced aggregation on the brain. This scoping review has focused on the pathophysiological mechanisms associated with peripheral and consequential neural (central) inflammation leading to COVID-19-related ischemic strokes. It also highlights the common biological processes shared between AIS and COVID-19 infection and the importance of the recognition that severe respiratory dysfunction and neurological impairments associated with COVID and chronic inflammation [post-COVID-19 neurological syndrome (PCNS)] may significantly impact recovery and ability to benefit from neurorehabilitation. This study provides a comprehensive review of the pathobiology of COVID-19 and ischemic stroke. It also affirms that the immunological contribution to the pathophysiology of COVID-19 is predictive of the neurological sequelae particularly ischemic stroke, which makes it the expectation rather than the exception. This work is of fundamental significance to the neurorehabilitation community given the increasing number of COVID-related ischemic strokes, the current limited knowledge regarding the risk of reinfection, and recent reports of a PCNS. It further highlights the need for global collaboration and research into new pathobiology-based neurorehabilitation treatment strategies and more integrated evidence-based care.
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