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- WSC TV - Live Session - Pre-Recorded Session with Live Q&A - On Demand Session (watch anytime) - Session with Voting
Does COVID-19 Really Cause Stroke: What Types and Why?
Despite the reduced number of stroke patient admissions during the first wave of the COVID-19 pandemic, which has been recorded worldwide, COVID-19 patients seem to be at a higher risk of stroke. SARS-CoV-2 infection may act as a trigger or risk factor for stroke, and it is more likely to cause thrombotic vascular events compared to other coronavirus and seasonal infectious diseases. A pooled analysis of the literature suggested that acute cerebrovascular events occurred in about 1.4% of patients hospitalized for COVID-19. Individuals with COVID-19 who experience a concomitant stroke are more likely to be older, have pre-existing cardiovascular comorbidities and severe infection from SARS-CoV-2.
Ischemic stroke is the commonest stroke subtype in COVID-19 patients, even if hemorrhagic stroke and cerebral venous thrombosis have also been described. COVID-19-associated stroke is characterized clinically by severe NIHSS and poor outcome, and radiologically by large artery occlusion and multiple arterial territory involvement.
The mechanisms of cerebrovascular manifestations in people with COVID-19 are likely multifactorial. They could be related to conventional stroke mechanisms or be directly caused by SARS-CoV-2 infection through specific pathophysiological mechanisms, leading to both ischemic and hemorrhagic stroke. The SARS-CoV-2 can affect the endothelium, cause downregulation of the renin-angiotensin system and promote a procoagulant state; also, it may involve the heart, leading to an increased risk of cardioembolism. Further studies are required to estimate the increased stroke risk in COVID-19 and to elucidate the pathophysiology linking COVID-19 to stroke.