SARS-CoV-2 and Acute Cerebrovascular Events: An Overview

Abstract

Since the coronavirus disease 2019 (COVID-19) pandemic, due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, accumulating evidence indicates that SARS-CoV-2 infection may be associated with various neurological manifestations, including acute cerebrovascular events (i.e., stroke and cerebral venous thrombosis). These events can occur prior to, during and even after the onset of COVID-19’s general symptoms. Although the mechanisms underlying the cerebrovascular complications in patients with COVID-19 are yet to be fully elucidated, the hypercoagulability state, inflammation and altered angiotensin-converting enzyme 2 (ACE-2) signaling in association with SARS-CoV-2 may play key roles. ACE-2 plays a critical role in preserving heart and brain homeostasis. In this review, we discuss the current state of knowledge of the possible mechanisms underlying the acute cerebrovascular events in patients with COVID-19, and we review the current epidemiological studies and case reports of neurovascular complications in association with SARS-CoV-2, as well as the relevant therapeutic approaches that have been considered worldwide. As the number of published COVID-19 cases with cerebrovascular events is growing, prospective studies would help gather more valuable insights into the pathophysiology of cerebrovascular events, effective therapies, and the factors predicting poor functional outcomes related to such events in COVID-19 patients.

Acute Arterial Thrombosis of Lower Extremities in COVID-19 Patients

“…The binding of SARS-CoV-2 to ACE-2 is a crucial element for viral infectivity and multi-organ damage. ACE-2 is expressed in various human tissues, such as the CNS, skeletal muscle, gastrointestinal tract, and endothelial cells [ 22 ].…”

Neurological effects of COVID‐19 in infants and children

“… 57 By comparison, there is concern among adult patients that strokes are more common, especially in younger adults, thought to be possibly related to vascular endothelial damage or hyperinflammation. 58 …”

Long‐term side effects and lingering symptoms post COVID‐19 recovery

“…49 Most recent reviews give more detailed mechanisms and complications of the Neuro COVID. [49][50][51][52] A retrospective cohort study of 6-month neurological and psychiatric outcome in 236,379 COVID-19 survivors along with 2 control cohort of 105,579 patients diagnosed with influenza and 236,038 patients diagnosed with respiratory tract infection has been recently published. 29 The COVID-19 cohort was further divided into and not attributable to alternative diagnosis.…”

“… 49 Most recent reviews give more detailed mechanisms and complications of the Neuro COVID. 49 , 50 , 51 , 52 …”

“…Peripheral nervous system (PNS) manifestations have also been reported including neuropathic pain, skeletal muscle injury and hyperCKaemia, Guillain‐Barré syndrome, cranial polyneuritis, neuromuscular junction disorders, neuro‐ophthalmological disorders, neurosensory hearing loss and dysautonomia 49 . Most recent reviews give more detailed mechanisms and complications of the Neuro COVID 49–52 …”