en Clinical Neuroscience Clinical Neuroscience Review Review <strong>Introduction</strong>: 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.<br> <strong>Methods</strong>: 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.<br> <strong>Results</strong>: 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.&nbsp;<br> <strong>Conclusion</strong>: 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. SARS-CoV-2, Stroke, Angiotensin-converting enzyme 2, Blood coagulation disorders, Cerebrovascular disorders 569 586 http://bcn.iums.ac.ir/browse.php?a_code=A-10-3277-1&slc_lang=en&sid=1 Samaneh Kazemi samaneh.kazemi@ymail.com 13700319475328460039360 13700319475328460039360 No Deputy of Research and Technology, Guilan University of Medical Sciences, Rasht, Iran. Arash Pourgholaminejad arash_pgn@yahoo.com 13700319475328460039361 13700319475328460039361 No Department of Immunology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Alia Saberi alia.saberi1@gmail.com 13700319475328460039362 13700319475328460039362 Yes Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.