COVID-19 and stroke: from the cases to the causes

被引:7
|
作者
Frisullo, Giovanni [1 ]
Scala, Irene [1 ,2 ]
Bellavia, Simone [1 ,2 ]
Broccolini, Aldobrando [1 ,2 ]
Brunetti, Valerio [1 ]
Morosetti, Roberta [1 ]
Della Marca, Giacomo [1 ,2 ]
Calabresi, Paolo [1 ,2 ]
机构
[1] Fdn Policlin Univ A Gemelli, IRCCS, UOC Neurol, Dipartimento Sci Invecchiamento Neurol Ortoped &, Largo A Gemelli 8, I-00168 Rome, Italy
[2] Univ Cattolica Sacro Cuore, Rome, Italy
关键词
COVID-19; D-dimer; intracranial bleeding; SARS-COV-2; small vessel; stroke; ACUTE ISCHEMIC-STROKE; C-REACTIVE PROTEIN; CORONAVIRUS; INFECTION; DISEASE; PATIENT; COMPLICATION; SARS-COV-2; PNEUMONIA; OCCLUSION;
D O I
10.1515/revneuro-2020-0136
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
During COVID-19 pandemic, a wide variety of stroke typologies have been described in patients affected by SARS-CoV-2. Investigating the case reports of acute stroke in COVID-19 patients, published since the beginning of the pandemic, we tried to trace the pathogenic mechanisms of stroke during SARS-CoV-2 infection. We conducted a systematic review analyzing demographic data, cerebrovascular risk factors, NIHSS score, vascular territory involvement and laboratory findings of 168 patients described in 89 studies, from a pool of 1243 records. Based on our results, we have identified different stroke profiles: (1) cerebral large vessel disease (CLVD) profile with a low disability, simultaneous onset of COVID-19 and stroke symptoms, good outcome and low serum levels of D-dimer and CRP; (2) intracranial bleeding (IB) profile with high disability, poor outcome and low levels of serum markers of inflammation and coagulopathy; (3) CLVD profile with a short time-lapse between COVID-19 symptoms and stroke onset, high neurological disability and very high systemic inflammatory markers; (4) multiple thrombo-embolic disease (MTED) profile with older patients, many comorbidities, disabling stroke, poor outcome, evident alteration of coagulation tests and high serum levels of both D-dimer and CRP. We therefore summarized these different profiles in a spectrum similar to that of visible light, where the violet-blue band included IB and CSVD with low inflammation and prothrombotic activity, the green-yellow band included CLVD with high inflammation and moderate prothrombotic activity and the orange-red band for MTED with moderate-high levels of inflammation and very high prothrombotic activity.
引用
收藏
页码:659 / 669
页数:11
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