Department of Neurology, Dalian Medical University, Dalian, Liaoning, China.
Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.
Int J Neurosci. 2023 Feb;133(2):176-185. doi: 10.1080/00207454.2021.1897588. Epub 2021 Mar 26.
As of November 28, 2020, COVID-19 has been reported in 220 countries with 61,036,793 confirmed cases and 1,433,316 confirmed deaths; countries became vigilant around the world. In addition to SARS-CoV-2 causing pneumonia, many studies have reported ischemic stroke in patients with COVID-19. This article describes the effects and possible underlying mechanisms of SARS-CoV-2 on ischemic stroke. A literature search was performed using PubMed, Web of Science, and other COVID-dedicated databases and the combination of the keywords 'SARS-CoV-2', 'COVID-19' and 'ischemic stroke' up to November 28, 2020. SARS-CoV-2 invades the host through angiotensin converting enzyme 2 (ACE2). ACE2 is expressed not only in the lungs, but also in the brain and vascular endothelial cells. SARS-CoV-2 infection might cause direct vascular disease or enhance the immunogenic thrombosis environment through several mechanisms. SARS-CoV-2 infection can modulate the host immune response and can cause inflammation, coagulation disorders, renin angiotensin system disorders, hypoxia, and stress disorders, which may lead to the occurrence of ischemic stroke. Some patients with COVID-19 can develop ischemic stroke. Ischemic stroke has a high risk of causing disability and is associated with a high mortality rate. It is hoped that when medical staff treat patients with COVID-19, they would pay attention to the occurrence of ischemic stroke to improve the prognosis of patients with COVID-19.
截至 2020 年 11 月 28 日，220 个国家和地区报告了 COVID-19 确诊病例 61036793 例，死亡病例 1433316 例；各国都提高了警惕。除了 SARS-CoV-2 引起肺炎外，许多研究还报告了 COVID-19 患者发生缺血性脑卒中。本文描述了 SARS-CoV-2 对缺血性脑卒中的影响及其可能的潜在机制。通过使用 PubMed、Web of Science 和其他 COVID 专用数据库进行文献检索，并结合 SARS-CoV-2、COVID-19 和缺血性脑卒中这三个关键词，检索至 2020 年 11 月 28 日。SARS-CoV-2 通过血管紧张素转化酶 2（ACE2）进入宿主。ACE2 不仅在肺部表达，也在大脑和血管内皮细胞中表达。SARS-CoV-2 感染可能通过多种机制导致直接血管疾病或增强免疫性血栓形成环境。SARS-CoV-2 感染可以调节宿主的免疫反应，引起炎症、凝血紊乱、肾素血管紧张素系统紊乱、缺氧和应激障碍，从而导致缺血性脑卒中的发生。一些 COVID-19 患者可能会发生缺血性脑卒中。缺血性脑卒中导致残疾的风险很高，与死亡率高有关。希望医务人员在治疗 COVID-19 患者时，注意缺血性脑卒中的发生，改善 COVID-19 患者的预后。
