Pathomechanism and Management of Stroke in COVID-19: Review of Immunopathogenesis, Coagulopathy, Endothelial Dysfunction, and Downregulation of ACE2
Rahmawati Putu Lohita, Tini Kumara, Susilawathi Ni Made, Wijayanti I. A. Sri, Samatra D. P. G. Purwa,
소속 상세정보
( Rahmawati Putu Lohita )
Udayana University Sanglah General Hospital Department of Neurology
( Tini Kumara )
Udayana University Udayana University Hospital Department of Neurology
( Susilawathi Ni Made )
Udayana University Udayana University Hospital Department of Neurology
( Wijayanti I. A. Sri )
Udayana University Udayana University Hospital Department of Neurology
( Samatra D. P. G. Purwa )
Udayana University Udayana University Hospital Department of Neurology
Abstract
Coronavirus 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.
키워드
stroke; COVID-19; hypercoagulability; inflammation; renin-angiotensin system
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