Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria Della Misericordia, Udine, Italy.
Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria Della Misericordia, Udine, Italy; Department of Medicine (DAME), University of Udine Medical School, Udine, Italy; Department of Mathematics, Informatics and Physics (DMIF), University of Udine, Udine, Italy.
Neurosci Lett. 2021 Jan 19;743:135564. doi: 10.1016/j.neulet.2020.135564. Epub 2020 Dec 19.
Acute cerebrovascular disease, particularly ischemic stroke, has emerged as a serious complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of the Coronavirus disease-2019 (COVID-19). Accumulating data on patients with COVID-19-associated stroke have shed light on specificities concerning clinical presentation, neuroimaging findings, and outcome. Such specificities include a propensity towards large vessel occlusion, multi-territory stroke, and involvement of otherwise uncommonly affected vessels. Conversely, small-vessel brain disease, cerebral venous thrombosis, and intracerebral hemorrhage appear to be less frequent. Atypical neurovascular presentations were also described, ranging from bilateral carotid artery dissection to posterior reversible encephalopathy syndrome (PRES), and vasculitis. Cases presenting with encephalopathy or encephalitis with seizures heralding stroke were particularly challenging. The pathogenesis and optimal management of ischemic stroke associated with COVID-19 still remain uncertain, but emerging evidence suggest that cytokine storm-triggered coagulopathy and endotheliopathy represent possible targetable mechanisms. Some specific management issues in this population include the difficulty in identifying clinical signs of stroke in critically ill patients in the intensive care unit, as well as the need for a protected pathway for brain imaging, intravenous thrombolysis, and mechanical thrombectomy, keeping in mind that "time is brain" also for COVID-19 patients. In this review, we discuss the novel developments and challenges for the diagnosis and treatment of stroke in patients with COVID-19, and delineate the principles for a rational approach toward precision medicine in this emerging field.
急性脑血管病，尤其是缺血性脑卒中，已成为严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的严重并发症，SARS-CoV-2 是 2019 年冠状病毒病（COVID-19）的病原体。关于 COVID-19 相关性脑卒中患者的大量数据揭示了其在临床表现、神经影像学特征和结局方面的一些特殊性。这些特殊性包括大血管闭塞、多区域脑卒中和不常见血管受累的倾向。相反，小血管脑疾病、脑静脉血栓形成和脑出血似乎较少见。也描述了一些不典型的神经血管表现，范围从双侧颈内动脉夹层到后部可逆性脑病综合征（PRES）和血管炎。以癫痫发作为先兆的脑病或脑炎预示着脑卒中的病例尤其具有挑战性。COVID-19 相关缺血性脑卒中的发病机制和最佳治疗方法仍不确定，但新出现的证据表明，细胞因子风暴引发的凝血异常和内皮功能障碍可能是可行的治疗靶点。在这一人群中，一些具体的管理问题包括在重症监护病房中识别脑卒中临床体征的困难，以及需要为脑影像学、静脉溶栓和机械取栓建立一个受保护的途径，因为 COVID-19 患者也需要“时间就是大脑”。在这篇综述中，我们讨论了 COVID-19 患者脑卒中诊断和治疗方面的新进展和挑战，并阐述了在这一新兴领域开展精准医学的合理方法的原则。
