What is the real impact of severe acute respiratory syndrome coronavirus-2 on stroke: Do we more have to learn?

Abstract

Objectives: Coronaviruses are an infectious disease with a considerable spectrum of clinical presentation. Neurologic symptoms related to severe acute respiratory syndrome coronavirus (SARS-CoV-2) have been described recently in the literature. Among a wide variety of neurological symptoms, acute cerebrovascular disease is one of the most serious complications. This review aimed to reveal the current knowledge regarding stroke in new coronavirus infection as a way to improve its diagnosis and treatments. Materials and Methods: A systematic literature review was carried out to identify the particularities of SARSCoV-2 in patients with stroke. An electronic search of the literature was conducted in the PubMed database between December 1, 2019, and June 11, 2020. A total of 693 articles were extracted. We included articles in all languages and conference papers, reviews, published letters, and editorials were excluded from the study. Results: Out of the 693 screened articles, 39 were selected for full-text review. Twenty-nine studies were excluded because they did not report stroke in COVID-19 patients. Thus, 10 papers were included in this review with a total of 22 patients. Conclusion: A vascular (ischemic or hemorrhagic) neurological complication is a real event that may occur in patients with COVID-19. There is strong evidence that vascular complications may arise for the most part due to the well-recognized potentially fatal inflammatory storm, which reflects a hyperactivation of inflammatory factors and dysfunction of the coagulation system, especially D-dimer and platelet abnormalities.