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. 2021 Feb 15;32(6):659-669.
doi: 10.1515/revneuro-2020-0136. Print 2021 Aug 26.

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

Giovanni Frisullo  1 , Irene Scala  1   2 , Simone Bellavia  1   2 , Aldobrando Broccolini  1   2 , Valerio Brunetti  1 , Roberta Morosetti  1 , Giacomo Della Marca  1   2 , Paolo Calabresi  1   2
Affiliations
Free article

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

Giovanni Frisullo et al. Rev Neurosci. .
Free article

Abstract

During COVID-19 pandemic, a wide variety of stroke typologies have been described in patients affected by SARS-CoV-2. Investigating the case reports of acute stroke in COVID-19 patients, published since the beginning of the pandemic, we tried to trace the pathogenic mechanisms of stroke during SARS-CoV-2 infection. We conducted a systematic review analyzing demographic data, cerebrovascular risk factors, NIHSS score, vascular territory involvement and laboratory findings of 168 patients described in 89 studies, from a pool of 1243 records. Based on our results, we have identified different stroke profiles: (1) cerebral large vessel disease (CLVD) profile with a low disability, simultaneous onset of COVID-19 and stroke symptoms, good outcome and low serum levels of D-dimer and CRP; (2) intracranial bleeding (IB) profile with high disability, poor outcome and low levels of serum markers of inflammation and coagulopathy; (3) CLVD profile with a short time-lapse between COVID-19 symptoms and stroke onset, high neurological disability and very high systemic inflammatory markers; (4) multiple thrombo-embolic disease (MTED) profile with older patients, many comorbidities, disabling stroke, poor outcome, evident alteration of coagulation tests and high serum levels of both D-dimer and CRP. We therefore summarized these different profiles in a spectrum similar to that of visible light, where the violet-blue band included IB and CSVD with low inflammation and prothrombotic activity, the green-yellow band included CLVD with high inflammation and moderate prothrombotic activity and the orange-red band for MTED with moderate-high levels of inflammation and very high prothrombotic activity.

Keywords: COVID-19; D-dimer; SARS-COV-2; intracranial bleeding; small vessel; stroke.

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