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

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

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Article number649922
JournalFrontiers in Cardiovascular Medicine
Volume8
DOIs
StatePublished - Mar 29 2021
Externally publishedYes

Keywords

  • blood coagulation
  • COVID-19
  • neuroimmunomodulation
  • pathophysiology
  • pharmacology
  • renin-angiotensin system
  • SARS-CoV-2
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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