Cerebrovascular and Neurological Dysfunction under the Threat of COVID-19: Is There a Comorbid Role for Smoking and Vaping?

Abstract

The recently discovered novel coronavirus, SARS-CoV-2 (COVID-19 virus), has brought the whole world to standstill with critical challenges, affecting both health and economic sectors worldwide. Although initially, this pandemic was associated with causing severe pulmonary and respiratory disorders, recent case studies reported the association of cerebrovascular-neurological dysfunction in COVID-19 patients, which is also life-threatening. Several SARS-CoV-2 positive case studies have been reported where there are mild or no symptoms of this virus. However, a selection of patients are suffering from large artery ischemic strokes. Although the pathophysiology of the SARS-CoV-2 virus affecting the cerebrovascular system has not been elucidated yet, researchers have identified several pathogenic mechanisms, including a role for the ACE2 receptor. Therefore, it is extremely crucial to identify the risk factors related to the progression and adverse outcome of cerebrovascular-neurological dysfunction in COVID-19 patients. Since many articles have reported the effect of smoking (tobacco and cannabis) and vaping in cerebrovascular and neurological systems, and considering that smokers are more prone to viral and bacterial infection compared to non-smokers, it is high time to explore the probable correlation of smoking in COVID-19 patients. Herein, we have reviewed the possible role of smoking and vaping on cerebrovascular and neurological dysfunction in COVID-19 patients, along with potential pathogenic mechanisms associated with it.

Assessing Vaping Views, Usage, and Vaping-Related Education Among Medical Students: A Pilot Study

“…Comorbidities due to vaping have been shown to render a person more susceptible to COVID-19. For instance, vaping weakens the blood-brain barrier and increases lung epithelial cell permeability, allowing easier viral access to the central nervous system and lungs [17,18]. Vaping has been implicated not only in the physiological consequences of COVID-19, but also in escalating the spread of the coronavirus pandemic.…”

Neurological Complications of SARS-CoV, MERS-CoV, and COVID-19

“…Most of the reported cases were associated with COVID-19, three articles for MERS-CoV, and one article for SARS-CoV. The proposed mechanism of causing stroke, as described in most of the articles, specifically in COVID-19 articles, depends on several factors [79][80][81][82]. The mechanism likely involves endothelial dysfunction, immune-mediated injury leading to cytokine storm and coagulation abnormalities, and hypoxiainduced injury.…”

Understanding the Immunologic Characteristics of Neurologic Manifestations of SARS-CoV-2 and Potential Immunological Mechanisms

“…SARS-CoV-2 patients present with elevated plasma levels of neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAP), which are known as biochemical indicators of neuronal injury and glial activation, respectively [ 9 ]. Also, postmortem brain autopsies demonstrate virus invasion to different brain regions, including the hypothalamus and olfactory bulb, accompanied by neural death and demyelination [ 10 , 11 ].…”