Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights

Divani, Afshin A.; Andalib, Sasan; Napoli, Mario Di; Lattanzi, Simona; Hussain, Muhammad Shazam; Biller, José; McCullough, Louise D.; Azarpazhooh, Mahmoud Reza; Seletska, Alina; Mayer, Stephan A.; Torbey, Michel T.

doi:10.1016/j.jstrokecerebrovasdis.2020.104941

Cited by 205 publications

(243 citation statements)

References 102 publications

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“…SARS-CoV-2 utilizes angiotensin-converting enzyme 2 (ACE2) receptors on host cells for its internalization. The spike (S) glycoprotein, a structural protein on the SARS-CoV-2 outer envelope, is activated by transmembrane protease, serine 2 (TMPRSS2), allowing the virion to bind to ACE2 [ 6 ••]. The S glycoprotein priming depends in part upon the endosomal cysteine proteases cathepsin B and cathepsin L [ 7 ].…”

Section: Neurotropism Of Sars-cov-2mentioning

confidence: 99%

“…In Spain, cerebrovascular diseases were seen in 14 (1.7%) of 841 COVID-19 patients including 11 patients with ischemic stroke and three patients with ICH [ 24 ••]. These patients may develop a more severe coagulopathy defined as COVID-19–associated coagulopathy, which may arise from inflammation, including inflammatory cytokine storm [ 6 ••]. Furthermore, SARS-CoV-2 induces downregulation of ACE2, which overactivates the classical RAS axis and underactivates the alternative RAS signaling in the brain [ 6 ••].…”

Section: Cns Manifestations Associated With Covid-19mentioning

confidence: 99%

“…These patients may develop a more severe coagulopathy defined as COVID-19–associated coagulopathy, which may arise from inflammation, including inflammatory cytokine storm [ 6 ••]. Furthermore, SARS-CoV-2 induces downregulation of ACE2, which overactivates the classical RAS axis and underactivates the alternative RAS signaling in the brain [ 6 ••]. The consequent imbalance in oxidative stress, vasodilation, neuroinflammation, and thrombogenesis may contribute to stroke pathophysiology of COVID-19 [ 6 ••].…”

Section: Cns Manifestations Associated With Covid-19mentioning

confidence: 99%

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Central Nervous System Manifestations Associated with COVID-19

Divani

Andalib

Biller

et al. 2020

Curr Neurol Neurosci Rep

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Purpose of Review Coronavirus disease 2019 (COVID-19) has become a global health crisis of our time. The disease arises from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that binds to angiotensin-converting enzyme 2 (ACE2) receptors on host cells for its internalization. COVID-19 has a wide range of respiratory symptoms from mild to severe and affects several other organs, increasing the complexity of the treatment. There is accumulating evidence to suggest that SARS-CoV-2 can target the nervous system. In this review, we provide an account of the COVID-19 central nervous system (CNS) manifestations. Recent Findings A broad spectrum of the CNS manifestations including headache, impaired consciousness, delirium, loss of smell and taste, encephalitis, seizures, strokes, myelitis, acute disseminated encephalomyelitis, neurogenic respiratory failure, encephalopathy, silent hypoxemia, generalized myoclonus, neuroleptic malignant syndrome and Kawasaki syndrome has been reported in patients with COVID-19. Summary CNS manifestations associated with COVID-19 should be considered in clinical practice. There is a need for modification of current protocols and standing orders to provide better care for COVID-19 patients presenting with neurological symptoms.

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Section: Neurotropism Of Sars-cov-2mentioning

confidence: 99%

Section: Cns Manifestations Associated With Covid-19mentioning

confidence: 99%

Section: Cns Manifestations Associated With Covid-19mentioning

confidence: 99%

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Central Nervous System Manifestations Associated with COVID-19

Divani

Andalib

Biller

et al. 2020

Curr Neurol Neurosci Rep

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“…Levels of this interleukin are generally low in children, but there is a short spurt in early childhood 19 , correlating with a recently described severe COVID-19 manifestation in young children, a Kawasaki-like condition 20 . IL-6 is also thrombogenic, which may well account for this signi cant cause of death from the virus 21 . Intense exercise also produces large quantities of IL-6 22 , which may account for the more severe clinical manifestations of infection amongst athletes 23 .…”

Section: Discussionmentioning

confidence: 99%

Premorbid IL-6 levels may predict mortality from COVID-19

Silberstein

2020

Preprint

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Purpose: There is evidence that interleukin-6 (IL-6) levels are elevated in cases of complicated COVID-19, but it is also possible that this cytokine has a far more important role in the pathogenesis of viral infection. Methods: Data on COVID-19 mortality from Italy and the UK were compared with previously published results of mean IL-6 levels from these countries as well as from the USA. Results: There was a highly significant correlation (r = 0.9883; p = 0.00025) between age-stratified mortality rates and IL-6 levels from similar healthy individuals. Levels of IL-6 were proportionately higher in males, the elderly, individuals of black ethnicity and obese individuals, with similar findings in relation to COVID-19 mortality in these groups. Conclusions: IL-6 levels prior to infection may predict mortality, given that this cytokine directly facilitates viral cell entry and replication. This provides a rationale for prophylactic and therapeutic measures directed at lowering IL-6, including Vitamin D prescription.

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“…Stroke patients and stroke care systems have been signi cantly affected during COVID-19 pandemic. On the one hand, COVID-19 can affect the cardiovascular and cerebrovascular systems [3] by downregulating the angiotensin-converting enzyme 2 and decreasing the activation of the alternative reninangiotensin system pathway in the brain [4], which may contribute to stroke during SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

Coronavirus Disease 2019 is Threatening Stroke Care Systems: Challenge and Management

Xin¹,

Huang²,

Liu³

et al. 2020

Preprint

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Background Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the stroke care systems have been seriously affected because of social restrictions and other reasons. As the pandemic spreads further to global, it is of great significant to understand how COVID-19 affect the stroke care systems. Methods We retrospectively studied the real-world data of one comprehensive stroke center in China from January to February, 2020, and compared it with the same period in 2019. We analyzed time from stroke onset to admission, severity, effect after treatment, hospital stays, cost of hospitalization, etc., and correlation among them. Results We observed a great extension of the onset-to-door time of stroke patients during the pandemic. The degree of neurological deficit of the patients was significantly higher, both admission and discharge. Longer onset-to-door time and higher degree of neurological deficit were significantly correlated with longer hospital stays and higher medical burden. Conclusions COVID-19 pandemic is threatening the stroke care systems. Measures must be taken to minimize the collateral damage caused by COVID-19.

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Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights

Cited by 205 publications

References 102 publications

Central Nervous System Manifestations Associated with COVID-19

Central Nervous System Manifestations Associated with COVID-19

Premorbid IL-6 levels may predict mortality from COVID-19

Coronavirus Disease 2019 is Threatening Stroke Care Systems: Challenge and Management

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