Sex differences in neurologic presentation and outcome of SARS-CoV-2, especially cerebrovascular manifestations

Abstract

Neurological manifestations of COVID-19 and their impact have not been well characterized. Neurological involvement may be caused directly by the effects of the virus infecting the brain or indirectly by the local and systemic immune responses against the virus. Acute cerebrovascular disease, particularly ischemic stroke, has emerged as a serious complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The arrival of COVID-19 represented a unique occasion to study sex difference, and accentuated the need for further study to elucidate the mechanisms that differentiate clinical outcomes among male and female patients. Recent pandemics has a clear sex disparity in clinical outcomes, and morbidity and mortality from COVID-19 are higher among men. Interestingly, the previous decade, there was sparse literature evaluating the impact of sex differences on outcomes in infectious diseases, especially on neurologic complications. Ongoing advances in scientific research have demonstrated sex differences in the neurological complications of neuroinfectious diseases, and sex and disparities in health care are frequently encountered. The evidence for potential sex differences and gender inequalities, including socioeconomic status and occupational exposure in the COVID-19 pandemic is continuing to emerge. In summary, sex is increasingly recognized as a critical determinant of health and disease, particularly relevant to the topical COVID-19 pandemic. Morbidity and mortality from COVID-19 are greater for males, however, the mechanisms for this difference are unclear. Understanding the differences in outcomes between males and females improve the effectiveness of health interventions. However, outcomes of the neurologic complications of infectious disease may be partially explained by sex differences in immune responses. With this narrative, we intend to provide the reader with a comprehensive coverage of where we currently stand regarding sex differences specific, especially on outcomes critical neurologic manifestations of the SARS-CoV-2 infection.