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Publications

Journal Article Review Epublish 24 citations

PubMed: 33855053 DOI: 10.3389/fcvm.2021.649922

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

Front Cardiovasc Med 8:649922

Authors: Saeideh Aghayari Sheikh Neshin, Shima Shahjouei, Eric Koza, Isabel Friedenberg, Faezeh Khodadadi, Mirna Sabra, Firas Kobeissy, Saeed Ansari, Georgios Tsivgoulis, Jiang Li, Vida Abedi, Donna M Wolk, Ramin Zand

Affiliations

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

Abstract

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.

MeSH

Sars-Cov-2, Stroke, Blood Coagulation, Neuroimmunomodulation, Covid-19, Pharmacology, Severe Acute Respiratory Syndrome-Related Coronavirus, Infections

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