Cerebrovascular Accident and SARS-CoV-19 (COVID-19): A Systematic Review

Abstract

<b><i>Background:</i></b> While the most common neurologic symptoms reported in patients affected by SARS-CoV-2 are headache, dizziness, myalgia, mental fog, and anosmia, there is a growing basis of published peer-reviewed cases reporting stroke in the setting of SARS-CoV-2 infection. The peer-reviewed literature suggests an increased risk of cerebrovascular accident (CVA) in the setting of COVID-19 infection. <b><i>Methods:</i></b> We searched 3 databases (PubMed, MEDLINE, and CINAHL) with search terms COVID-19, novel coronavirus, stroke, and cerebrovascular accident. Case series and case studies presenting patients positive for both COVID-19 and CVA published from January 1 through September 1, 2020, were included. Data collection and analysis was completed and risk of bias assessed. <b><i>Results:</i></b> The search identified 28 studies across 7 counties comprising 73 patients. Amongst patients hospitalized for COVID-19 infection and CVA, the average age was 60; the most common preexisting conditions were hypertension and diabetes mellitus, and those without preexisting conditions were significantly younger with an average age of 47. Amongst hospitalized patients with COVID-19 and CVA, there was a bimodal association with COVID-19 infection severity with majority of patients classified with mild or critical COVID-19 infection. <b><i>Discussion:</i></b> The data suggest SARS-CoV-2 is a risk factor for developing stroke, particularly in patients with hypertension and diabetes. Furthermore, the younger average age of stroke in patients with SARS-CoV-2, particularly those patients with zero identifiable preexisting conditions, creates high suspicion that SARS-CoV-2 is an independent risk factor for development of stroke; however, this cannot yet be proven without comparable control population. The data suggest the risk of developing CVA in the setting of COVID-19 infection is not dependent upon severity of illness. Continued studies must be done to understand the epidemiologic factors of COVID-19 infection and stroke and the pathophysiology of the COVID-associated hypercoagulable state.

Prevalence of Hypertension and Diabetes in Severe COVID-19: A Cross-Sectional Study from Single Center, Kabul

“…The median age of severe COVID patients was 63 years. The finding is consistent with other studies, including a systematic review that reported an average age of 60 years in hospitalized, 3 and a study involving 5700 hospitalized patients that reported a median age of 63. 4 However, it is worth noting that some studies have reported lower age estimates, such as 53.2 years for severe patients 5 and a median age of 52 years for severe cases.…”

The Evolution and Treatment Options of Patients With Covid-19 and Neurological Manifestations – A Narrative Review

“…Stroke is a known neurological complication that substantially increases the disease severity and death risk in COVID-19 patients [87] and vice versa, patients with a more severe COVID-19 form are more predisposed to develop cerebrovascular diseases [71]. Although, in another systematic review, the authors state that there seems to be no association between COVID-19 severity and the risk of developing cerebrovascular disorders [6]. Apart from stroke, delirium was also linked to higher disease severity in COVID-19 patients as it leads to prolonged hospitalization, need for ICU admission, or in-hospital mortality [45,85].…”

The Influence of COVID-19 in Endocrine Research: Critical Overview, Methodological Implications and a Guideline for Future Designs

“…Pathophysiologically, COVID-19 infection has been associated with altered male reproduction, 81 olfactory dysfunctions, 82 abnormal liver function tests, 83 neurologic conditions, 84 cerebrovascular events, 85 hypovitaminosis D, 86 dysgeusia, 87 obesity, 88 and perturbations in energy homeostasis 89 just to mention a few. For instance, high-energy expenditure driven by a high metabolic state induced by the host response may quickly lead to depletion of the micronutrient.…”