Cerebral microvascular complications associated with SARS-CoV-2 infection: How did it occur and how should it be treated?

Omidian, Neda; Mohammadi, Pantea; Sadeghalvad, Mona; Mohammadi-Motlagh, Hamid-Reza

doi:10.1016/j.biopha.2022.113534

Cited by 7 publications

(10 citation statements)

References 185 publications

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“…Previous studies have shown that comorbidities and advanced age are independent risk factors for mortality in patients with COVID-19. [5–7] This study has come up with some new conclusions that will change many previous perceptions.…”

Section: Introductionmentioning

confidence: 76%

Risk prediction for severe COVID-19 progressing to critical illness and death in the ICU and efficacy analysis of using traditional Chinese medicine

Tang,

Ye,

Zhou

et al. 2024

Medicine

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To reveal the key factors influencing the progression of severe COVID-19 to critical illness and death in the intensive care unit (ICU) and to accurately predict the risk, as well as to validate the efficacy of treatment using traditional Chinese medicine (TCM), thus providing valuable recommendations for the clinical management of patients. A total of 189 patients with COVID-19 in 25 ICUs in Chongqing, China, were enrolled, and 16 eventually died. Statistical models shown that factors influencing the progression of COVID-19 to critical illness include the severity of illness at diagnosis, the mode of respiratory support, and the use of TCM. Risk factors for death include a history of metabolic disease, the use of antiviral drugs and TCM, and invasive endotracheal intubation. The area under curve of the noncollinearity model predicted the risk of progression to critical illness and the risk of death reached 0.847 and 0.876, respectively. The use of TCM is an independent protective factor for the prevention of the progression of severe COVID-19, while uncorrectable hypoxemia and invasive respiratory support are independent risk factors, and antiviral drugs can help reduce mortality. The multifactorial prediction model can assess the risk of critical illness and death in ICU COVID-19 patients, and inform clinicians in choosing the treatment options and medications.

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Section: Introductionmentioning

confidence: 76%

Risk prediction for severe COVID-19 progressing to critical illness and death in the ICU and efficacy analysis of using traditional Chinese medicine

Tang,

Ye,

Zhou

et al. 2024

Medicine

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“…Anticoagulation use associated with increased risk of ICH in patients with COVID-19 was also reported by Melmed et al [ 43 ]. In a different study, since cerebral microhaemorrhages are increasingly being recognized as a complication of COVID-19 [ 44 ], Dixon et al investigated the potential pathophysiology through assessing the pattern of microhaemorrhage and clinical characteristics of patients with COVID-19 [ 45 ]. Dixon et al concluded that the pattern of cerebral microhaemorrhage is similar to the pattern reported in patients without COVID-19 who are critical ill and other causes of severe hypoxia rising questions regarding whether microhaemorrhage occurs from endothelial dysfunction due the direct effect of SARS-CoV-2 infection or from the secondary effects of critical illness and hypoxia [ 45 ].…”

Section: Underlying Pathophysiology Mechanisms Of Sars-cov-2mentioning

confidence: 99%

“…In a recent neuropathological study, infected primates consistently presented with brain microhaemorrhages, and SARS-CoV-2 could be detected in the cerebral vasculature, but not the parenchyma [ 22 , 44 ]. Additionally, perivascular inflammation and microangiopathy were encountered in the majority of brain autopsies from patients with COVID-19 [ 46 – 49 ].…”

Section: Clinical Cerebrovascular Manifestation Of Sars-cov-2mentioning

confidence: 99%

Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review

Stefanou¹,

Karvelas

Bennett

et al. 2023

Curr Treat Options Neurol

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Purpose of review The risks of cerebrovascular manifestations due to SARS-CoV-2 infection are significantly increased within the first 6 months of the infection. Our work aims to give an update on current clinical aspects of diagnosis and treatment of cerebrovascular manifestations during acute and long-term SARS-CoV-2 infection. Recent findings The incidence of acute ischemic stroke and haemorrhagic stroke during acute SARS-CoV-2 patients is estimated at 0.9 to 4.6% and 0.5–0.9%, respectively, and were associated with increased mortality. The majority presented with hemiparesis, dysarthria, sensory deficits, and a NIHSS score within 5–15. In addition, beyond the first 30 days of infection people with COVID-19 exhibited increased risk of stroke. During acute phase, age, hypertension, diabetes, and medical history of vascular disease were increased in patients with COVID-19 with new onset of cerebrovascular manifestations, while during long-COVID-19, the risk of cerebrovascular manifestations were found increased regardless of these factors. The management of patients with large-vessel ischemic stroke fulfilling the intravenous thrombolysis criteria are successfully treated according to the guidelines, while hyperosmolar therapy is typically administered in 4- to 6-h intervals. In addition, prophylaxis of anticoagulation therapy is associated with a better prognosis and low mortality during acute and post hospital discharge of patients with COVID-19. Summary In this work, we provide a comprehensive review of the current literature on acute and post-acute COVID-19 cerebrovascular sequelae, symptomatology, and its pathophysiology mechanisms. Moreover, we discuss therapeutic strategies for these patients during acute and long-term care and point populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease are more likely to develop cerebrovascular complications.

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“…Growing evidence suggests that the function of the blood–brain barrier (BBB) could be partly disrupted by SARS-CoV-2. For instance, the elevated inflammatory immune response and cytokine storm could affect endothelial cells and then lead to increased BBB permeability ( Fotuhi et al, 2020 ; Omidian et al, 2022 ). Furthermore, increased BBB permeability induced by the SARS-CoV-2 envelope protein was also found in vitro ( Buzhdygan et al, 2020 ; Ju et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Non-neutralizing antibodies to SARS-Cov-2-related linear epitopes induce psychotic-like behavior in mice

Wei

You

et al. 2023

Front. Mol. Neurosci.

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ObjectiveAn increasing number of studies have reported that numerous patients with coronavirus disease 2019 (COVID-19) and vaccinated individuals have developed central nervous system (CNS) symptoms, and that most of the antibodies in their sera have no virus-neutralizing ability. We tested the hypothesis that non-neutralizing anti-S1-111 IgG induced by the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could negatively affect the CNS.MethodsAfter 14-day acclimation, the grouped ApoE-/- mice were immunized four times (day 0, day 7, day 14, day 28) with different spike-protein-derived peptides (coupled with KLH) or KLH via subcutaneous injection. Antibody level, state of glial cells, gene expression, prepulse inhibition, locomotor activity, and spatial working memory were assessed from day 21.ResultsAn increased level of anti-S1-111 IgG was measured in their sera and brain homogenate after the immunization. Crucially, anti-S1-111 IgG increased the density of microglia, activated microglia, and astrocytes in the hippocampus, and we observed a psychomotor-like behavioral phenotype with defective sensorimotor gating and impaired spontaneity among S1-111-immunized mice. Transcriptome profiling showed that up-regulated genes in S1-111-immunized mice were mainly associated with synaptic plasticity and mental disorders.DiscussionOur results show that the non-neutralizing antibody anti-S1-111 IgG induced by the spike protein caused a series of psychotic-like changes in model mice by activating glial cells and modulating synaptic plasticity. Preventing the production of anti-S1-111 IgG (or other non-neutralizing antibodies) may be a potential strategy to reduce CNS manifestations in COVID-19 patients and vaccinated individuals.

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Cerebral microvascular complications associated with SARS-CoV-2 infection: How did it occur and how should it be treated?

Cited by 7 publications

References 185 publications

Risk prediction for severe COVID-19 progressing to critical illness and death in the ICU and efficacy analysis of using traditional Chinese medicine

Risk prediction for severe COVID-19 progressing to critical illness and death in the ICU and efficacy analysis of using traditional Chinese medicine

Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review

Non-neutralizing antibodies to SARS-Cov-2-related linear epitopes induce psychotic-like behavior in mice

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