Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology

• Main Authors: Saeideh Aghayari Sheikh Neshin, Shima Shahjouei, Eric Koza, Isabel Friedenberg, Faezeh Khodadadi, Mirna Sabra, Firas Kobeissy, Saeed Ansari, Georgios Tsivgoulis, Jiang Li, Vida Abedi, Donna M. Wolk, Ramin Zand
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2021-03-01
• Series: Frontiers in Cardiovascular Medicine
• Subjects: SARS-CoV-2; COVID-19; stroke; pathophysiology; pharmacology; neuroimmunomodulation
• Online Access: https://www.frontiersin.org/articles/10.3389/fcvm.2021.649922/full

Since the early days of the pandemic, there have been several reports of cerebrovascular complications during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Numerous studies proposed a role for SARS-CoV-2 in igniting stroke. In this review, we focused on the pathoetiology of stroke among the infected patients. We pictured the results of the SARS-CoV-2 invasion to the central nervous system (CNS) via neuronal and hematogenous routes, in addition to viral infection in peripheral tissues with extensive crosstalk with the CNS. SARS-CoV-2 infection results in pro-inflammatory cytokine and chemokine release and activation of the immune system, COVID-19-associated coagulopathy, endotheliitis and vasculitis, hypoxia, imbalance in the renin-angiotensin system, and cardiovascular complications that all may lead to the incidence of stroke. Critically ill patients, those with pre-existing comorbidities and patients taking certain medications, such as drugs with elevated risk for arrhythmia or thrombophilia, are more susceptible to a stroke after SARS-CoV-2 infection. By providing a pictorial narrative review, we illustrated these associations in detail to broaden the scope of our understanding of stroke in SARS-CoV-2-infected patients. We also discussed the role of antiplatelets and anticoagulants for stroke prevention and the need for a personalized approach among patients with SARS-CoV-2 infection.