How is ischemic stroke linked to a COVID-19-infected patient different from other cardiovascular risk factors? a case
1Pharmacy Department, All Africa Leprosy, Tuberculosis and Rehabilitation Training Center, Zenebework, Kolfe Keranio, Addis Ababa, Ethiopia.
Insights
Acute coronavirus disease 2019 (COVID-19) can cause ischemic stroke by directly infecting endothelial cells and triggering inflammation. This increases the risk of stroke, particularly in older individuals and those with pre-existing risk factors.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Biology
Background:
- Ischemic stroke is a known neurological complication of acute coronavirus disease 2019 (COVID-19).
- Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infects endothelial cells, leading to inflammation and potentially ischemic stroke.
- COVID-19 infection and associated inflammatory responses contribute to vascular damage, hypercoagulability, and thrombin activation, increasing stroke risk.
Purpose of the Study:
- To investigate the link between COVID-19 infection and ischemic stroke.
- To elucidate the mechanisms by which SARS-CoV-2 contributes to stroke development.
- To highlight the increased risk of stroke in COVID-19 patients, especially those with risk factors.
Main Methods:
- Review of existing literature on COVID-19 and stroke.
- Analysis of the pathophysiological mechanisms of SARS-CoV-2 infection on the vascular system.
- Case presentation of a patient with COVID-19 and ischemic stroke.
Main Results:
- COVID-19 patients have a higher incidence of ischemic stroke, particularly large infarctions due to major artery thrombosis.
- Neurological symptoms, including stroke, can manifest 3-14 days after COVID-19 onset.
- SARS-CoV-2 can migrate to the central nervous system, contributing to neurological complications.
Conclusions:
- COVID-19 significantly increases the risk of ischemic stroke, especially in older individuals and those with comorbidities like hypertension, obesity, and diabetes.
- The virus's direct endothelial infection and systemic inflammatory response are key mechanisms driving stroke risk.
- Prompt recognition and management of stroke in COVID-19 patients are crucial, considering the potential for in-hospital mortality.
Abstract:
Ischemic stroke is a recognized neurological consequence of an acute coronavirus disease 2019 (COVID-19) infection. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly infects endothelial cells, generating widespread endothelial inflammation. This may be the mechanism leading to an ischemic stroke. Infection with SARS-CoV-2 and inflammatory responses cause vascular damage, hypercoagulability, thrombin activation, platelet aggregation, and plaque shedding as a result of hemodynamic alterations, which increase the risk of ischemic stroke.
Case Presentation:
On 19 September 2022, 3 h after the commencement of the right-sided weakness, a 61-year-old black African male farmer was sent to transported to the emergency room. When an radiography of the chest was performed, it showed diffuse bilateral infiltrates, coarse, slightly bilateral crepitation, and scattered reticulations. Cardiovascular testing of the patient turned up nothing unexpected. The eye-opening reaction was 1/4 (no eye opening) on the Glasgow Coma Scale, the motor response was 3/6 (abnormal flexion), and the verbal response was 3/5 (inappropriate words). When his breathing became difficult, he needed five intranasal doses of oxygen every minute to maintain saturation. He started taking low-dose aspirin daily for a month at 81 mg. He took consumed 75 mg of clopidogrel once a day for a month.
Clinical Discussion:
Stroke was associated with in-hospital death among hospitalized patients with the COVID-19 infection. In patients who have risk factors for stroke, such as high blood pressure, obesity, and diabetes, COVID-19 increases the risk of stroke. The risk of stroke was highest in older people within the first few days after receiving a COVID-19 diagnosis.
Conclusion:
Patients with COVID-19 are more likely to get an ischemic stroke from large infarctions, mostly as a result of major artery thrombosis. From the start of COVID-19 signs, neurological problems can appear anywhere between 3 and 14 days later. Due to severe inflammation, immobility, hypoxia, and diffuse intravascular coagulation, SARS-CoV-2 also possesses neurological invasive capabilities and may migrate from the respiratory system to the central nervous system.
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