Stroke in patients infected by the novel coronavirus and its causal mechanisms: A narrative review

Abstract

Objective: The current study aimed to evaluate the mechanisms of stroke development during the coronavirus disease 2019 (COVID-19) pandemic and analyze the related characteristics, such as etiology, age group, associated comorbidities, and prognosis.

Neurological Complications of COVID-19 in the Elderly

“…As already noted, the ACE2 receptors used by SARS-CoV-2 for entering cells are present on neuron and glial cell surfaces [11]. High ACE2 receptor concentrations in the brain are also seen in the olfactory bulb, substantia nigra, and the middle temporal and posterior cingulate gyri [12].…”

“…It has been noted that the virus can have a direct action on brain tissue in COVID-19 patients. ACE2 receptors, which SARS-CoV-2 uses to enter cells, are present on neuron and glial cell surfaces [11]. Two possible pathways for entry of the virus into the brain have been considered: retrograde axonal transport from peripheral olfactory neurons and across the BBB, which becomes permeable because of vascular endothelial damage and the development of an infl ammatory response [7,12,13].…”

“…Studies indicate that patients with IS and COVID-19 receiving anticoagulant therapy have mortality two times lower than in those not receiving prophylactic doses of anticoagulants [29]. However, careful evaluation of the risks and benefi ts of using anticoagulants must be made, as disordered and unevidenced use can lead to the development of hemorrhagic complications [11]. Intravenous administration of Alteplase can also increase the risk of hemorrhagic transformation in COVID-19.…”

“…The development of hemorrhagic stroke in COVID-19 patients almost doubles the risk of lethal outcome [31]. Studies have indicated that hemorrhagic complications are typical of younger patients [11]. More than half of pa-es in 65-70% of cases [18,19], while IS is due to cardioembolism in 9.9-22% of cases [19,20].…”