Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology

Abstract

Since the early days of the pandemic, there have been several reports of cerebrovascular complications during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Numerous studies proposed a role for SARS-CoV-2 in igniting stroke. In this review, we focused on the pathoetiology of stroke among the infected patients. We pictured the results of the SARS-CoV-2 invasion to the central nervous system (CNS) via neuronal and hematogenous routes, in addition to viral infection in peripheral tissues with extensive crosstalk with the CNS. SARS-CoV-2 infection results in pro-inflammatory cytokine and chemokine release and activation of the immune system, COVID-19-associated coagulopathy, endotheliitis and vasculitis, hypoxia, imbalance in the renin-angiotensin system, and cardiovascular complications that all may lead to the incidence of stroke. Critically ill patients, those with pre-existing comorbidities and patients taking certain medications, such as drugs with elevated risk for arrhythmia or thrombophilia, are more susceptible to a stroke after SARS-CoV-2 infection. By providing a pictorial narrative review, we illustrated these associations in detail to broaden the scope of our understanding of stroke in SARS-CoV-2-infected patients. We also discussed the role of antiplatelets and anticoagulants for stroke prevention and the need for a personalized approach among patients with SARS-CoV-2 infection.

Bilateral Basal Ganglia Infarction and Bilateral Thalamic Lesions in Sudanese Pediatric Patient with COVID-19 and Malaria Co-Infection, a Case Report

“…An important role in activating the in ammatory system and chemical release is related to direct activation of the immune system, platelets, and endothelial cells by SARS-CoV-2. Vascular events including stroke may be due to the increased in ammatory responses through various mechanisms [5]. Vascular hemostasis and blood ow are maintained by endothelial cells.…”

Immune Responses against SARS-CoV-2—Questions and Experiences

“…It is now well established that COVID-19 also affects the vascular [133][134][135][136][137][138] and the clotting system [139][140][141][142][143][144]. Thus, it is not surprising that SARS-CoV-2 vaccinations were brought into connection with clotting disturbances including serious thrombotic thrombocytopenia.…”

Anticoagulant therapy for stroke prevention in patients with severe COVID-19

“…В ходе исследования наблюдались случаи летального исхода инсульта, что указывает на взаимное усугубление тяжести течения обоих заболеваний. Вирусная инвазия и воспалительная реакция при заболевании, вызванном SARS-CoV-2, способствуют развитию васкулита, приводят к эндотелиальной дисфункции и прокоагулянтному состоянию, а также дополнительно повышают риск тромботических событий [2,3,11,18]. Эндотелиальная дисфункция в сочетании с лечением антикоагулянтами и имеющаяся сопутствующая патология могут привести к ГИ и геморрагической трансформации ИИ у пациентов с COVID-19, что необходимо учитывать при составлении алгоритма лечения пациента [18].…”