de Oliveira Roberta Marina Ferreira, de Souza Aguiar Pedro Henrique Chaves, de Paula Raphael Wellerson Rodrigues Mayrink, Simões Carlos Eduardo Nardouto, Almeida Lucas Garrido, Barceló Alberto, Galil Arise Garcia de Siqueira
Faculty of Medicine Federal University of Juiz de Fora (UFJF) Juiz de Fora Minas Gerais Brazil.
Department of Public Health Science University of Miami Miami Florida USA.
J Am Coll Emerg Physicians Open. 2020 Dec 26;2(1):e12332. doi: 10.1002/emp2.12332. eCollection 2021 Feb.
The current study aimed to evaluate the mechanisms of stroke development during the coronavirus disease 2019 (COVID-19) pandemic and analyze the related characteristics, such as etiology, age group, associated comorbidities, and prognosis.
A narrative was performed using the descriptors ["novel coronavirus"] AND ["stroke"] in the PubMed, Science Direct, Google Scholar, Lilacs, and Biblioteca Virtual em Saúde (BVS) databases, including studies published between December 1, 2019, and April 28, 2020.
A total of 142 articles were identified, with 89 of them in the PubMed database, 46 in Science Direct, and 7 in Google Scholar. No articles were found using the defined keywords in the Lilacs and BVS databases. A total of 22 articles were included for final evaluation. We observed that infection by the novel coronavirus caused a greater risk of the occurrence of stroke, with several studies suggesting etiological mechanisms, such as the involvement of angiotensin-converting enzyme 2, viral invasion, and hypoxia as well as the increase in D-dimer and the reduction in platelets, which had been commonly observed in COVID-19 cases. The most common complication of stroke was found among the elderly with preexisting comorbidities, mainly cardiovascular disease. We detected reports of strokes among young people with no preexisting risk factors for thromboembolic events, in which the mechanism related to the viral infection was the most probable cause. In this review, we confirmed that stroke is part of the spectrum of clinical manifestations resulting from COVID-19 and is associated with a worse prognosis. Cerebrovascular lesions resulting from complications of the infection by the novel coronavirus occurred as a result of ischemic, hemorrhagic, and/or thromboembolic etiologies.
The occurrence of stroke during the pandemic as a result of the novel coronavirus has a multifactorial character, and emergency physicians should focus on systematic measures for its screening and accurate diagnosis as well as on appropriate interventions based on early decisionmaking that may have a favorable impact on reducing damage and saving lives.
本研究旨在评估2019年冠状病毒病（COVID-19）大流行期间中风发生的机制，并分析相关特征，如病因、年龄组、合并症及预后。
在PubMed、Science Direct、谷歌学术、Lilacs和虚拟健康图书馆（BVS）数据库中使用描述符["新型冠状病毒"] AND ["中风"]进行叙述性检索，纳入2019年12月1日至2020年4月28日发表的研究。
共识别出142篇文章，其中89篇来自PubMed数据库，46篇来自Science Direct，7篇来自谷歌学术。在Lilacs和BVS数据库中未找到使用定义关键词的文章。最终纳入22篇文章进行评估。我们观察到新型冠状病毒感染会增加中风发生风险，多项研究提示了病因机制，如血管紧张素转换酶2的参与、病毒侵袭、缺氧以及D-二聚体升高和血小板减少，这些在COVID-19病例中较为常见。中风最常见的并发症发生在有合并症的老年人中，主要是心血管疾病。我们发现了无血栓栓塞事件既往危险因素的年轻人发生中风的报道，其中病毒感染相关机制最可能是病因。在本综述中，我们证实中风是COVID-19所致临床表现谱的一部分，且与较差的预后相关。新型冠状病毒感染并发症导致的脑血管病变是由缺血性、出血性和/或血栓栓塞性病因引起的。
新型冠状病毒大流行期间中风的发生具有多因素特征，急诊医生应注重系统的筛查措施、准确诊断以及基于早期决策的适当干预，这可能对减少损害和挽救生命产生有利影响。
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