Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China.
Key Laboratory of Organ Transplantation, Ministry of Education, Chinese Academy of Medical Sciences, Wuhan, China.
Neurol Sci. 2022 Jan;43(1):67-79. doi: 10.1007/s10072-021-05679-0. Epub 2021 Oct 21.
Coronavirus disease 2019 (COVID-19), the third type of coronavirus pneumonia after severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), is spreading widely worldwide now. This pneumonia causes not only respiratory symptoms but also multiple organ dysfunction, including thrombotic diseases such as ischemic stroke. The purpose of this review is to explore whether COVID-19 is a risk factor for ischemic stroke and its related pathophysiological mechanisms. Based on the high thrombosis rate and frequent strokes of COVID-19 patients, combined with related laboratory indicators and pathological results, the discussion is mainly from two aspects: nerve invasion and endothelial dysfunction. SARS-CoV-2 can directly invade the CNS through blood-borne and neuronal retrograde pathways, causing cerebrovascular diseases. In addition, the endothelial dysfunction in COVID-19 is almost certain. Cytokine storm causes thromboinflammation, and downregulation of ACE2 leads to RAS imbalance, which eventually lead to ischemic stroke.
新型冠状病毒病（COVID-19），是继严重急性呼吸综合征（SARS）和中东呼吸综合征（MERS）之后的第三种冠状病毒肺炎，目前正在全球范围内广泛传播。这种肺炎不仅会引起呼吸道症状，还会导致多器官功能障碍，包括血栓性疾病如缺血性中风。本综述旨在探讨 COVID-19 是否是缺血性中风的危险因素及其相关的病理生理机制。基于 COVID-19 患者的高血栓形成率和频繁发生的中风，结合相关的实验室指标和病理结果，讨论主要从两个方面展开：神经侵袭和内皮功能障碍。SARS-CoV-2 可通过血源性和神经元逆行途径直接侵犯中枢神经系统，引起脑血管疾病。此外，COVID-19 中的内皮功能障碍几乎是确定的。细胞因子风暴引起血栓炎症，ACE2 的下调导致 RAS 失衡，最终导致缺血性中风。
