Volume 12, Issue 5 (September & October 2021)                   BCN 2021, 12(5): 569-586 | Back to browse issues page

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Kazemi S, Pourgholaminejad A, Saberi A. Stroke Associated with SARS-CoV-2 Infection and its Pathogenesis: A Systematic Review. BCN. 2021; 12 (5) :569-586
URL: http://bcn.iums.ac.ir/article-1-2119-en.html
1- Deputy of Research and Technology, Guilan University of Medical Sciences, Rasht, Iran.
2- Department of Immunology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
3- Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Introduction: In this systematic review, we will discuss the change of stroke incidence during the COVID-19 pandemic period and the proposed mechanisms of the relationship between SARS-CoV-2 and stroke.
Methods: Web of Science, PMC/Medline, and Scopus databases were searched until July 2020 without time and language limitations. After quality assessment, 22 articles were included in this study.
Results: Based on the results, it is impossible to conclude any definite relationship between the rising or decreasing stroke frequency or the shift in the ischemic and hemorrhagic ratio and SARS-CoV-2 infection. However, it appears that SARS-CoV-2 infection has some correlation with stroke. The supposed mechanisms for the SARS-CoV-2-related hemorrhagic stroke include 1) SARS-CoV-2-related vasculopathy with the endothelial damage of small vessels, 2) viral infection-induced platelet dysfunction or thrombocytopenia, and 3) activation of the proinflammatory cascade leading to coagulopathy. The helpful strategies are receiving therapeutic anticoagulation for high D-dimer or a known thrombus due to SARS-CoV-2 infection, as well as using extracorporeal membrane oxygenation (ECMO) in some patients. Furthermore, the possible mechanisms for the SARS-CoV-2-related ischemic stroke include 1) dysregulation of angiotensin-converting enzyme 2 (a key host cellular receptor for SARS-CoV-2)-related physiologic functions, 2) endothelial cell damages, 3) thrombo-inflammation, and 4) coagulopathy and coagulation abnormalities related to SARS-CoV-2 infection. 
Conclusion: A better understanding of the SARS-CoV-2 pathogenesis and its relation to neurologic abnormalities such as stroke can help to design new therapeutic approaches.
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Type of Study: Review | Subject: Clinical Neuroscience
Received: 2021/03/9 | Accepted: 2021/07/24 | Published: 2021/09/1

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