Tsivgoulis Georgios, Palaiodimou Lina, Zand Ramin, Lioutas Vasileios Arsenios, Krogias Christos, Katsanos Aristeidis H, Shoamanesh Ashkan, Sharma Vijay K, Shahjouei Shima, Baracchini Claudio, Vlachopoulos Charalambos, Gournellis Rossetos, Sfikakis Petros P, Sandset Else Charlotte, Alexandrov Andrei V, Tsiodras Sotirios
Second Department of Neurology, School of Medicine, National & Kapodistrian University of Athens, Rimini 1, Chaidari, Athens 12462, Greece.
Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, 'Attikon' University Hospital, Athens, Greece.
Ther Adv Neurol Disord. 2020 Dec 8;13:1756286420978004. doi: 10.1177/1756286420978004. eCollection 2020.
Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as 'red flags' to alarm clinicians in recognizing COVID-19-related stroke.
在新型严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染期间，神经学表现并不罕见。据报道，脑血管疾病与2019冠状病毒病（COVID-19）之间存在明确关联。然而，这种关联是因果关系还是偶然关系仍不清楚。在这篇叙述性综述中，我们试图阐述将COVID-19与脑血管疾病联系起来的可能病理生理机制，描述中风综合征及其预后，并讨论一些可能有助于在COVID-19期间迅速识别脑血管疾病的临床、放射学和实验室特征。我们进行了系统的文献检索，并提取了相关信息。血管紧张素转换酶2受体失调、失控的免疫反应和炎症、凝血病、COVID-19相关的心脏损伤及随后的心源性栓塞、危重病和长期住院引起的并发症，都可能是导致多种脑血管临床表现的潜在致病机制。在COVID-19患者的病例报告和队列研究中，已经描述了急性缺血性中风、脑出血和脑静脉窦血栓形成，患病率在0.5%至5%之间。在不同的队列研究中，与SARS-CoV-2阴性中风患者相比，SARS-CoV-2阳性中风患者的死亡率更高，出院时功能预后更差，住院时间更长。特定的人口统计学、临床、实验室和放射学特征可作为“红旗”，提醒临床医生识别与COVID-19相关的中风。
