COVID-19 and stroke: A review

Abstract

COVID-19 patients have presented with a wide range of neurological disorders, among which stroke is the most devastating. We have reviewed current studies, case series, and case reports with a focus on COVID-19 patients complicated with stroke, and presented the current understanding of stroke in this patient population. As evidenced by increased D-dimer, fibrinogen, factor VIII and von Willebrand factor, SARS-CoV-2 infection induces coagulopathy, disrupts endothelial function, and promotes hypercoagulative state. Collectively, it predisposes patients to cerebrovascular events. Additionally, due to the unprecedented strain on the healthcare system, stroke care has been inevitably compromised. The underlying mechanism between COVID-19 and stroke warrants further study, so does the development of an effective therapeutic or preventive intervention.

Keywords: ACE2, Angiotensin-converting enzyme 2; COVID-19; COVID-19, Coronavirus disease 2019; CPR, C-reactive protein; CVD, Cerebrovascular disease; Cerebrovascular diseases; DIC, Disseminated intravascular coagulation; ECMO, Extracorporeal membrane oxygenation; ICH, Intracranial hemorrhage; IL-6, Interleukin-6; MERS, Middle East Respiratory Syndrome; NIHSS, National Institutes of Health Stroke Scale; PT, Prothrombin time; SARS-CoV-1, Severe acute respiratory syndrome coronavirus 1; SARS-CoV-2; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; Stroke; TNF-alpha, Tumor necrosis factor-alpha; aPL, Antiphospholipid; aPTT, Activated partial thromboplastin time; rt-PCR, Reverse transcription polymerase chain reaction; vWF, Von Willebrand Factor.

Fig. 1

Pathophysiology and Management of Ischemic Stroke in COVID-19.