The emerging association between COVID-19 and acute stroke

• Published in: Trends in neurosciences (Regular ed.) Vol. 44; no. 7; pp. 527 - 537
• Main Authors: Stein, Laura K., Mayman, Naomi A., Dhamoon, Mandip S., Fifi, Johanna T.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2021
• Subjects: cerebrovascular disease; coronavirus; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - virology; Humans; pandemic; Prevalence; Review; SARS-COV-2; SARS-CoV-2 - pathogenicity; Stroke - complications; Stroke - mortality; Stroke - virology; thrombectomy; thrombolysis; thrombosis; Thrombosis - complications; Thrombosis - mortality; Thrombosis - virology; cerebrovascular disease; thrombosis; SARS-COV-2; thrombectomy; thrombolysis; coronavirus; pandemic
• ISSN: 0166-2236; 1878-108X
• DOI: 10.1016/j.tins.2021.03.005

Prior to COVID-19, only two human-tropic coronaviruses resulted in epidemics and cerebrovascular disease was rarely reported. Evidence now suggests that 1–6% of hospitalized COVID-19 patients develop stroke. According to some reports, stroke risk is more than sevenfold greater in patients with COVID-19 than influenza. Concerningly, outcomes of COVID-19-related stroke are often worse than in stroke patients without COVID-19 from the same cohorts. In this review, we highlight the emerging association between COVID-19 and stroke and discuss putative pathogenetic mechanisms. Etiology of stroke in COVID-19 patients is likely multifactorial, related to coagulopathy, inflammation, platelet activation, and alterations to the vascular endothelium. Significant work remains to be done to better understand the pathogenesis of COVID-19-related stroke and for designing optimal primary and secondary prevention strategies.
Growing comparisons of COVID-19 positive and COVID-19 negative stroke cohorts support an association between COVID-19 and stroke.COVID-19-related stroke can be severe and has impacted young patients and minimally symptomatic individuals, as well as patients with traditional cerebrovascular risk factors and severe disease.When compared with stroke patients without COVID-19, morbidity and mortality are much worse in patients with stroke and COVID-19.Etiology of COVID-19-related stroke is frequently unknown and the pathogenesis may be related to coagulopathy, inflammation, endotheliopathy, and platelet activation.Anticoagulation may benefit those hospitalized with severe COVID-19, including those diagnosed with stroke.