Keywords
SARS-CoV-2
Stroke
Cerebrovascular diseases
Pathophysiology
Categories
How to Cite
Abstract
Since the outbreak of COVID-19 pandemic, multiple associated symptoms have been described, pointing out the neurological symptoms contributing to increase in mortality, amongst them, the stroke; therefore we carried out a bibliographic review to understand the physiopathology of COVID-19 that may trigger a stroke, either ischemic or haemorrhagic; it is stated that it is associated to a hypercoagulability status due to the interaction of the virus with its main pathway of entry, this being the Angiotensin Converting Enzyme-2.
A conclusion has been reached that the presence of COVID-19 in conjunction with comorbidities and cardiovascular risk factors of the patient, lead to develop it in a more catastrophic way.
In regards to the management of stroke secondary to COVID-19 infection, the usual treatment both acute as well as for secondary prevention has been used, however, a high rate of morbidity and mortality has been detected, particularly with cases of haemorrhagic stroke; it is currently recommended the use of anticoagulants in an individualized way.
Despite the studies obtained on its pathophysiology, it is not clear what events trigger an stroke whilst infected with COVID-19, however, they are all aimed at the condition of hypercoagulability, endothelial dysfunction and microthrombosis, derived from the binding of viral glycoprotein S (spike) to angiotensine converting enzyme 2 (ACE2) causing alteration in the renin-angiotensin-aldosterone system (RAAS), so it is necessary to wait for more studies and results to know fully the relationship of COVID-19 with the presence of stroke.
References
Abootalebi S, Aertker BM, Andalibi MS, Asdaghi N, Aykac O, Azarpazhooh MR, et al. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE). J Stroke Cerebrovasc Dis [Internet]. 2020 Sep;29(9):104938. DOI: 10.1016/j.jstrokecerebrovasdis.2020.104938
Yamakawa M, Kuno T, Mikami T, Takagi H, Gronseth G. Clinical Characteristics of Stroke with COVID-19: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis. 2020 Dec 1;29(12). DOI: 10.1016/j.jstrokecerebrovasdis.2020.105288
Health WHO, Programme E, Panel EA, Preparedness IPC, Guidance IPC, Group D, et al. Transmission of SARS-CoV-2: implications for infection prevention precautions. 2020;(July):1–10.
Organización Panamericana de la Salud / Organización Mundial de la Salud [Internet]. 2020. Available from: https://bit.ly/3kDwe33
CDMX G. Resumen de casos COVID 19 en la Ciudad de México [Internet]. Ciudad de México; 2021. Available from: http://covid19.cdmx.gob.mx/storage/app/media/Reportes CSP/CS_28_MARZO_Nocturno_compressed.pdf
Beyrouti R, Adams ME, Benjamin L, Cohen H, Farmer SF, Goh YY, et al. Characteristics of ischaemic stroke associated with COVID-19. Vol. 91, Journal of Neurology, Neurosurgery and Psychiatry. BMJ Publishing Group; 2020. p. 889–91. DOI: 10.1136/jnnp-2020-323586
Divani AA, Andalib S, Di Napoli M, Lattanzi S, Hussain MS, Biller J, et al. Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights. J Stroke Cerebrovasc Dis. 2020;29(8). DOI: 10.1016/j.jstrokecerebrovasdis.2020.104941
Snell J. SARS-CoV-2 infection and its association with thrombosis and ischemic stroke: a review. Vol. 40, American Journal of Emergency Medicine. W.B. Saunders; 2021. p. 188–92. DOI:10.1016/j.ajem.2020.09.072
Altable M, de la Serna JM. Cerebrovascular disease in COVID-19: Is there a higher risk of stroke? Brain, Behav Immun - Heal. 2020;6(May 2020):100092. DOI: 10.1016/j.bbih.2020.100092
Lou M, Yuan D, Liao S, Tong L, Li J. Potential mechanisms of cerebrovascular diseases in COVID-19 patients. Journal of NeuroVirology. Springer Science and Business Media Deutschland GmbH; 2021. DOI:10.1007/s13365-021-00948-2
David Spence J, De Freitas GR, Pettigrew LC, Ay H, Liebeskind DS, Kase CS, et al. Mechanisms of Stroke in COVID-19. Vol. 49, Cerebrovascular Diseases. S. Karger AG; 2020. p. 451–8. DOI: 10.1159/000509581
Zakeri A, Jadhav AP, Sullenger BA, Nimjee SM. Ischemic stroke in COVID-19-positive patients: An overview of SARS-CoV-2 and thrombotic mechanisms for the neurointerventionalist. J Neurointerv Surg. 2020;202–6. DOI:10.1136/neurintsurg-2020-016794
Nannoni S, de Groot R, Bell S, Markus HS. Stroke in COVID-19: A systematic review and meta-analysis. Vol. 16, International Journal of Stroke. SAGE Publications Inc.; 2021. p. 137–49. DOI: 10.1177/1747493020972922
Hess DC, Eldahshan W, Rutkowski E. COVID-19-Related Stroke. Vol. 11, Translational Stroke Research. Springer; 2020. p. 322–5. DOI: 10.1007/s12975-020-00818-9
Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol. 2020 Sep 1;5(3):279–84. DOI: 10.1136/svn-2020-000431
Yaghi S, Ishida K, Torres J, Mac Grory B, Raz E, Humbert K, et al. SARS-CoV-2 and Stroke in a New York Healthcare System. Stroke. 2020;2002–11. DOI: 10.1161/STROKEAHA.120.030335
Pranata R, Huang I, Lim MA, Wahjoepramono EJ, July J. Impact of cerebrovascular and cardiovascular diseases on mortality and severity of COVID-19–systematic review, meta-analysis, and meta-regression. J Stroke Cerebrovasc Dis. 2020 Aug 1;29(8). DOI: 10.1016/j.jstrokecerebrovasdis.2020.104949
Requena M, Olivé-Gadea M, Muchada M, García-Tornel Á, Deck M, Juega J, et al. COVID-19 and Stroke: Incidence and Etiological Description in a High-Volume Center. J Stroke Cerebrovasc Dis. 2020 Nov 1;29(11). DOI: 10.1016/j.jstrokecerebrovasdis.2020.105225
Ntaios G, Michel P, Georgiopoulos G, Guo Y, Li W, Xiong J, et al. Characteristics and Outcomes in Patients with COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke. Lippincott Williams and Wilkins; 2020. p. 254–8. DOI: 10.1161/STROKEAHA.120.031208
Vogrig A, Gigli GL, Bnà C, Morassi M. Stroke in patients with COVID-19: Clinical and neuroimaging characteristics. Neurosci Lett. 2021;743(September 2020). DOI: 10.1016/j.neulet.2020.135564
Siow I, Lee KS, Zhang JJY, Saffari SE, Ng A, Young B. Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence, Outcomes and Predictors: Stroke and COVID-19. J Stroke Cerebrovasc Dis [Internet]. 2021;30(3):105549. DOI:10.1016/j.jstrokecerebrovasdis.2020.105549
Aggarwal G, Lippi G, Michael Henry B. Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): A pooled analysis of published literature. Vol. 15, International Journal of Stroke. SAGE Publications Inc.; 2020. p. 385–9. DOI: 10.1177/1747493020921664
Tan YK, Goh C, Leow AST, Tambyah PA, Ang A, Yap ES, et al. COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis. 2020 Oct 1;50(3):587–95. DOI: 10.1007/s11239-020-02228-y
Ramos-Araque ME, Siegler JE, Ribo M, Requena M, López C, de Lera M, et al. Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry. BMC Neurol [Internet]. 2021 Dec 30;21(1):43. DOI: 10.1186/s12883-021-02075-1
Matías-Guiu J, Gomez-Pinedo U, Montero-Escribano P, Gomez-Iglesias P, Porta-Etessam J, Matias-Guiu JA. Should we expect neurological symptoms in the SARS-CoV-2 epidemic? Vol. 35, Neurologia. Spanish Society of Neurology; 2020. p. 170–5. DOI: 10.1016/j.nrl.2020.03.001
Dogra S, Jain R, Cao M, Bilaloglu S, Zagzag D, Hochman S, et al. Hemorrhagic stroke and anticoagulation in COVID-19. J Stroke Cerebrovasc Dis. 2020 Aug 1;29(8). DOI: 10.1016/j.jstrokecerebrovasdis.2020.104984
Qureshi AI, Abd-Allah F, Al-Senani F, Aytac E, Borhani-Haghighi A, Ciccone A, et al. Management of acute ischemic stroke in patients with COVID-19 infection: Insights from an international panel. Am J Emerg Med. 2020 Jul 1;38(7):1548.e5-1548.e7. DOI:10.1016/j.ajem.2020.05.018
Qureshi AI, Abd-Allah F, Al-Senani F, Aytac E, Borhani-Haghighi A, Ciccone A, et al. Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel. Int J Stroke. 2020 Jul 1;15(5):540–54. DOI:10.1177/1747493020923234
Requena M, Olivé-Gadea M, Muchada M, García-Tornel Á, Deck M, Juega J, et al. COVID-19 and Stroke: Incidence and Etiological Description in a High-Volume Center. J Stroke Cerebrovasc Dis. 2020;29(11):1–8. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105225
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2021 Ictus