Coronavirus Disease-2019 and Stroke: Pathophysiology and Management

Abstract

Severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease-2019, has been associated with an increased risk for ischemic and hemorrhagic stroke. As data emerge about the underlying mechanisms, it is important to synthesize current knowledge to improve effective treatment options. In this review, we highlight the known pathophysiology, discuss the relationship between ischemic and hemorrhagic stroke, and address emerging implications for patient management. The information here is compiled to be a user-friendly, quick guide to help practitioners select management options for these patients.

Elevated troponin levels as a predictor of mortality in patients with acute stroke: a systematic review and meta-analysis

“…The COVID-19 pandemic has placed unprecedented strain on stroke services globally, disrupting healthcare delivery and raising concerns about its impact on stroke outcomes ( 85 ). Despite these challenges, our meta-analysis did not identify any explicit instances linking the pandemic with influential impacts on stroke management or patient outcomes across included studies.…”

A rare clinical presentation after COVID-19: Manic episode with psychotic features

“…Additionally, one of the symptoms of the patient in the current study was hemiparesis accompanying acute-onset psychiatric symptoms, which may implicate a neuroinvasive effect of the virus. It has been reported that subarachnoid hemorrhage, ischemic and hemorrhagic stroke could be induced by SARS-CoV-2 with several mechanisms including hypercoagulability, dysregulated renin-angiotensin system, endothelial dysfunction, and neuroinvasion ( Panther and Lucke-Wold, 2022 , Small et al, 2022 ). Although hemiparesis has been previously associated with the concurrent ischemic stroke in COVID-19, as far as we know, this is the first patient developed hemiparesis without an ischemic cerebrovascular incident, in the literature ( Hamidi et al, 2020 ).…”

Real-time continuous image guidance for endoscopic retrograde cholangiopancreatography based on 3D/2D registration and respiratory compensation

“…COVID-19 has also been associated with an increased risk for ischemic and hemorrhagic strokes[ 21 ], conditions often treated with a vascular intervention procedure very similar to TACE that is achieved by embolizing the vessels connected to the aneurysm. Unlike liver vessels, intracranial vessels are not affected by respiratory motion and remain static with the use of X-ray images for guidance.…”