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Case Reports
. 2023 Feb 3;15(1):11-23.
doi: 10.1159/000529122. eCollection 2023 Jan-Dec.

COVID-19-Associated Cerebrovascular Events: A Case Series Study and a Literature Review of Possible Mechanisms

Mostafa Meshref  1 , Ibrahim M Hewila  1   2 , Yahia Khlidj  3 , Rafik Korissi  3 , Nour Shaheen  4 , Abdulqadir J Nashwan  5 , Yassamine Ouerdane  6 , Yara Amro  7 , Khaled M Taher  8 , Mahmoud Galal Ahmed  1
Affiliations
Case Reports

COVID-19-Associated Cerebrovascular Events: A Case Series Study and a Literature Review of Possible Mechanisms

Mostafa Meshref et al. Case Rep Neurol. .

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects multiple body systems, including the nervous system. Cerebrovascular accidents can also occur. Patients with comorbid illnesses have severe manifestations and poor outcomes. Despite the proper mechanism of SARS-CoV-2 infection-associated stroke having not yet been settled, various possible mechanisms have been hypothesized. One possibility is that the virus causes endothelial dysfunction and immune-mediated injury. Another possibility is that the trans-neuronal spread of the virus affects brain tissue. In addition, hypercoagulability caused by SARS-CoV-2 infection could lead to a stroke. A virus-induced dysfunction of the renin-angiotensin system could also lead to a stroke. The immune response and vasculitis resulting from SARS-CoV-2 infection are also possible causes via a cytokine storm, immune dysfunction, and various inflammatory responses. SARS-CoV-2 infection may affect calcitonin gene-related peptides and cerebral blood flow and may lead to stroke. Finally, SARS-CoV-2 may cause hemorrhagic strokes via mechanisms stimulated by its interaction with angiotensin-converting enzyme 2 (ACE2), leading to arterial wall damage and blood pressure changes. In this article, we will present seven cases of stroke-associated SARS-CoV-2 infection.

Keywords: Cytokine storm; Hemorrhagic stroke; Immune dysfunction; Severe acute respiratory syndrome coronavirus 2; Stroke.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1.
Fig. 1.
MRI brain coronal view showed left cerebellar infarction (red arrow).
Fig. 2.
Fig. 2.
CT brain without contrast showed left parieto-occipital infarction (red arrow).
Fig. 3.
Fig. 3.
CT brain showed old left subcortical lacunar infarction with right-side effacement and ribboning of the greater sulcus (blue arrow) and small hypodense area at right parietal (red arrow).
Fig. 4.
Fig. 4.
CT brain showed an ill-defined hypodense area in the right temporoparietal lobe with cortical and subcortical distribution in the region of the right middle cerebral artery and signs of hyperdense vessels associated with effacement of related cortical sulci (blue arrow).
Fig. 5.
Fig. 5.
MRI brain showed small left basal ganglia areas of restricted diffusion, denoting recent ischemic insult (red arrow).
Fig. 6.
Fig. 6.
CT brain showed a right frontoparietal hypodense area with perifocal edema (red arrow) and a left hypodense area that indicated bilateral subacute ischemic stroke (blue arrow).
Fig. 7.
Fig. 7.
Noncontrast CT brain showed (a) intracerebral hemorrhage in the basal ganglia (blue arrows) with lateral and third ventricle intraventricular extension (red arrows) (b) the fourth ventricle intraventricular extension (blue arrow).
Fig. 8.
Fig. 8.
Possible mechanisms of stroke associated with COVID-19.
See this image and copyright information in PMC

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