Pathomechanism and Management of Stroke in COVID-19: Review of Immunopathogenesis, Coagulopathy, Endothelial Dysfunction, and Downregulation of ACE2

J Clin Neurol. 2021 Apr;17(2):155-163. doi: 10.3988/jcn.2021.17.2.155.ABSTRACTCoronavirus disease 2019 (COVID-19) can reportedly manifest as an acute stroke, with most cases presenting as large vessel ischemic stroke in patients with or without comorbidities. The exact pathomechanism of stroke in COVID-19 remains ambiguous. The findings of previous studies indicate that the most likely underlying mechanisms are cerebrovascular pathological conditions following viral infection, inflammation-induced endothelial dysfunction, and hypercoagulability. Acute endothelial damage due to inflammation triggers a coagulation cascade, thrombosis propagation, and destabilization of atherosclerosis plaques, leading to large-vessel occlusion and plaque ulceration with concomitant thromboemboli, and manifests as ischemic stroke. Another possible mechanism is the downregulation of angiotensin-converting enzyme 2 as the target action of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Acute stroke management protocols need to be modified during the COVID-19 pandemic in order to adequately manage stroke patients with COVID-19.PMID:33835735 | PMC:PMC8053537 | DOI:10.3988/jcn.2021.17.2.155

Source: Journal of Clinical Neurology - April 9, 2021 Category: Neurology Authors: Putu Lohita Rahmawati Kumara Tini Ni Made Susilawathi I A Sri Wijayanti Dpg Purwa Samatra Source Type: research