COVID-19 and cerebrovascular diseases: a comprehensive overview
Open Access
- 1 January 2020
- journal article
- review article
- Published by SAGE Publications in Therapeutic Advances in Neurological Disorders
Abstract
Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.This publication has 152 references indexed in Scilit:
- Concomitant delayed posthypoxic leukoencephalopathy and critical illness microbleedsNeurology Clinical Practice, 2018
- Critical Illness–Associated Cerebral MicrobleedsStroke, 2017
- Therapeutic potential of the renin angiotensin system in ischaemic strokeExperimental & Translational Stroke Medicine, 2016
- Prevalence of Triggering Factors in Acute Stroke: Hospital-based Observational Cross-sectional StudyJournal of Stroke and Cerebrovascular Diseases, 2015
- CNS VasculitisSeminars in Neurology, 2014
- Impact of ACE2 Deficiency and Oxidative Stress on Cerebrovascular Function With AgingStroke, 2012
- Poststroke Depression: A ReviewThe Canadian Journal of Psychiatry, 2010
- Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation.2001
- Towards Definition, Clinical and Laboratory Criteria, and a Scoring System for Disseminated Intravascular CoagulationThrombosis and Haemostasis, 2001