Ischaemic stroke and SARS-CoV-2 infection: a causal or incidental association?

Barrios-López, J.M.; Rego-García, I.; Martínez, C. Muñoz; Romero-Fábrega, Juan Carlos; Rodríguez, M. Rivero; Gimenez, Jaume; Escamilla‐Sevilla, Francisco; Minguez-Castellanos, Adolfo; Perez, Martina

doi:10.1016/j.nrleng.2020.05.008

Cited by 29 publications

(41 citation statements)

References 21 publications

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“…On the other hand, studies by Viguier et al ( 50 ) and Gunasekaran et al ( 56 ) reported the absence of antiphospholipid antibodies. For the procalcitonin titres, three studies had a blood test result of below 1.0 mg/mL, which ranged from 0.23 to 0.8 ng/mL ( 43 , 44 , 52 ), with the highest mean for procalcitonin concentration reported in the study by Avula et al (4.9 ng/mL) ( 42 ). We observed that only three studies captured information on interleukin-6 (IL-6) levels among patients with COVID-19 and stroke, which ranged from 3 to 10.5 pg/mL, which are the studies by Avula et al ( 42 ), Barios Lopez et al ( 44 ), and Yaghi et al ( 36 ).…”

Section: Resultsmentioning

confidence: 99%

“…A total sample of 8,771 participants was included in the systematic review. These studies were conducted in many countries worldwide including in China ( 13 , 40 , 43 ), France ( 37 , 39 , 48 , 50 ), India ( 42 ), Iran ( 51 ), Italy ( 32 , 33 , 46 ), the Netherlands ( 34 ), Philippines ( 52 ), Spain ( 44 , 53 ), Turkey ( 58 ), UK ( 41 , 55 ), and the USA ( 21 , 35 , 36 , 45 , 47 , 49 , 54 , 56 , 57 ). Out of 27 studies, eight studies were of retrospective cohort study design, 11 were case series, and nine were case reports.…”

Section: Resultsmentioning

confidence: 99%

“…The numbers of stroke were almost equal for LVO (47 stroke cases in 10 studies) and non-LVO (42 cases in 10 studies). Location of LVOs involved were M1 vessels ( 21 , 37 , 41 , 42 , 44 , 45 , 47 , 53 , 54 ), M2 vessel ( 41 , 42 , 44 , 45 , 47 , 53 ), internal carotid ( 21 , 37 , 42 , 45 , 47 , 53 ), multiteritorial ( 37 , 47 ), posterior cerebral ( 41 , 45 ), basilar ( 37 ), ACA ( 21 , 53 ), and the vertebral artery ( 41 ).…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, a majority of the studies did not capture information on the presence of antiphospholipid, except the studies by Helms et al ( 39 ), Beyrouti et al ( 41 ), Zhang et al ( 43 ), Barios Lopez et al ( 44 ), Zayet et al ( 48 ), Fara et al ( 49 ), and Goldberg et al ( 57 ), in which these studies reported positive findings for the presence of antiphospholipid antibodies. On the other hand, studies by Viguier et al ( 50 ) and Gunasekaran et al ( 56 ) reported the absence of antiphospholipid antibodies.…”

Section: Resultsmentioning

confidence: 99%

“…Data of all these studies reported a normal reading for IL-6 levels. For the troponin test, seven studies reported data on the troponin concentration ( 33 , 41 – 44 , 48 , 52 ). Three out of the seven studies reported an abnormally elevated troponin concentration, which were 1338.9 pg/mL ( 43 ), 791.3 pg/mL ( 48 ), and 145 pg/mL, respectively ( 52 ).…”

Section: Resultsmentioning

confidence: 99%

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Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

et al. 2020

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Background: As the world witnessed the devastation caused by the coronavirus disease 2019 (COVID-19) outbreak, a growing body of literature on COVID-19 is also becoming increasingly available. Stroke has increasingly been reported as a complication of COVID-19 infection. However, a systematic synthesis of the available data has not been conducted. Therefore, we performed a systematic review and meta-analysis of currently available epidemiological, clinical, and laboratory data related to both stroke and COVID-19 infection. Methods: We systematically searched Medline, Cinahl, and PubMed for studies related to stroke and COVID-19 from inception up to June 4, 2020. We selected cohort studies, case series, and case reports that reported the occurrence of stroke in COVID-19 patients. A fixed-effects model was used to estimate the pooled frequency of stroke in COVID-19 patients with a 95% confidence interval (CI). Results: Twenty-eight studies were included in the systematic review and seven studies for the meta-analysis. The pooled frequency of stroke in COVID-19 patients was 1.1% (95% CI: 0.8, 1.3). The heterogeneity was low ( I 2 = 0.0%). Even though the frequency of stroke among patients having COVID-19 infection was low, those with concomitant COVID-19 infection and stroke suffered from a more severe infection and eventually had a poorer prognosis with a higher mortality rate (46.7%) than COVID-19 alone. Many COVID-19 patients shared the common traditional risk factors for stroke. We noted that ischemic stroke involving the anterior circulation with large vessels occlusion is the most common type of stroke with more strokes seen in multi-territorial regions, suggesting systemic thromboembolism. An elevated level of D-dimers, C-reactive protein, ferritin, lactic acid dehydrogenase, troponin, ESR, fibrinogen, and a positive antiphospholipid antibody were also noted in this review. Conclusions: The occurrence of stroke in patients with COVID-19 infection is uncommon, but it may pose as an important prognostic marker and indicator of severity of infection, by causing large vessels occlusion and exhibiting a thrombo-inflammatory vascular picture. Physicians should be made aware and remain vigilant on the possible two-way relationship between stroke and COVID-19 infection. The rate of stroke among patients with COVID-19 infection may increase in the future as they share the common risk factors.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

et al. 2020

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A review of ischemic stroke in COVID-19: currently known pathophysiological mechanisms

Tang

Zheng

2021

Neurol Sci

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Coronavirus disease 2019 (COVID-19), the third type of coronavirus pneumonia after severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), is spreading widely worldwide now. This pneumonia causes not only respiratory symptoms but also multiple organ dysfunction, including thrombotic diseases such as ischemic stroke. The purpose of this review is to explore whether COVID-19 is a risk factor for ischemic stroke and its related pathophysiological mechanisms. Based on the high thrombosis rate and frequent strokes of COVID-19 patients, combined with related laboratory indicators and pathological results, the discussion is mainly from two aspects: nerve invasion and endothelial dysfunction. SARS-CoV-2 can directly invade the CNS through blood-borne and neuronal retrograde pathways, causing cerebrovascular diseases. In addition, the endothelial dysfunction in COVID-19 is almost certain. Cytokine storm causes thromboinflammation, and downregulation of ACE2 leads to RAS imbalance, which eventually lead to ischemic stroke.

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SARS-CoV-2 RNA elements share human sequence identity and upregulate hyaluronan via NamiRNA-enhancer network

Yang

et al. 2022

eBioMedicine

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Ischaemic stroke and SARS-CoV-2 infection: a causal or incidental association?

Cited by 29 publications

References 21 publications

Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

A review of ischemic stroke in COVID-19: currently known pathophysiological mechanisms

SARS-CoV-2 RNA elements share human sequence identity and upregulate hyaluronan via NamiRNA-enhancer network

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