Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology

Frontiers in Cardiovascular Medicine

Isabel Friedenberg¹  Jiang Li²  Vida Abedi³  Eric Koza⁴  Donna M. Wolk⁵  Saeed Ansari⁶  Shima Shahjouei⁷  Ramin Zand⁷  Saeideh Aghayari Sheikh Neshin⁸  Mirna Sabra⁹  Faezeh Khodadadi^1,10  Firas Kobeissy^1,11  Georgios Tsivgoulis^1,12 

[1] Department of Biology, Pennsylvania State University, State College, PA, United States;Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, United States;Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, United States;Biocomplexity Institute, Virginia Tech, Blacksburg, VA, United States;Geisinger Commonwealth School of Medicine, Scranton, PA, United States;Molecular and Microbial Diagnostics and Development, Diagnostic Medicine Institute, Laboratory Medicine, Geisinger Health System, Danville, PA, United States;National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, United States;Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, United States;Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran;Neurosciences Research Center (NRC), Lebanese University/Medical School, Beirut, Lebanon;PES University, Bengaluru, India;Program of Neurotrauma, Neuroproteomics and Biomarker Research (NNBR), University of Florida, Gainesville, FL, United States;Second Department of Neurology, School of Medicine, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece;

关键词: SARS-CoV-2;    COVID-19;    stroke;    pathophysiology;    pharmacology;    neuroimmunomodulation;    renin-angiotensin system;    blood coagulation;   

DOI  :  10.3389/fcvm.2021.649922

来源: Frontiers

【 摘 要 】

Since the early days of the pandemic, there have been several reports of cerebrovascular complications during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Numerous studies proposed a role for SARS-CoV-2 in igniting stroke. In this review, we focused on the pathoetiology of stroke among the infected patients. We pictured the results of the SARS-CoV-2 invasion to the central nervous system (CNS) via neuronal and hematogenous routes, in addition to viral infection in peripheral tissues with extensive crosstalk with the CNS. SARS-CoV-2 infection results in pro-inflammatory cytokine and chemokine release and activation of the immune system, COVID-19-associated coagulopathy, endotheliitis and vasculitis, hypoxia, imbalance in the renin-angiotensin system, and cardiovascular complications that all may lead to the incidence of stroke. Critically ill patients, those with pre-existing comorbidities and patients taking certain medications, such as drugs with elevated risk for arrhythmia or thrombophilia, are more susceptible to a stroke after SARS-CoV-2 infection. By providing a pictorial narrative review, we illustrated these associations in detail to broaden the scope of our understanding of stroke in SARS-CoV-2-infected patients. We also discussed the role of antiplatelets and anticoagulants for stroke prevention and the need for a personalized approach among patients with SARS-CoV-2 infection.

【 授权许可】

CC BY