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Life
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Stroke and COVID-19: Pathophysiological Links, Clinical Implications and Stroke Care...
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Stroke and COVID-19: Pathophysiological Links, Clinical Implications and Stroke Care in Times of the Pandemic

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Epidemiology".

Deadline for manuscript submissions: closed (31 July 2022) | Viewed by 20166

Special Issue Editors

Dr. Timo Siepmann

E-Mail Website
Guest Editor
Department of NeurologyUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Interests: neurovascular disorders; clinical neuroscience; autonomic nervous system disorders; neuropharmacology; psychophamacology
Special Issues, Collections and Topics in MDPI journals
Dr. Kristian Barlinn

E-Mail Website
Guest Editor
Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Interests: diagnosis and therapy of neurovascular diseases; intensive care

Special Issue Information

Dear Colleagues,

The coronavirus disease 2019 (COVID-19) pandemic has affected stroke care globally as shown by multiple reports of decreased rates of hospital admissions and reperfusion therapy for acute ischemic stroke. Moreover, cumulative evidence substantiates an increased stroke risk for COVID-19 patients, which might be explained by altered blood coagulability and systemic inflammation leading to endothelial damage as well as platelet activation and stasis. Tailored strategies for ensuring the access of SARS-CoV-2-positive patients to multidisciplinary stroke care, monitoring COVID-19 patients for neurological symptoms and optimizing the treatment of patients with COVID-19-associated stroke are urgently needed.

In this Special Issue, we aim to provide a platform for original research, literature reviews and reports on novel and meaningful cases that address this significant research gap and will contribute to improving stroke care in this time of the COVID-19 pandemic.

Dr. Timo Siepmann
Dr. Kristian Barlinn
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • stroke
  • COVID-19
  • intracerebral hemorrhage
  • cerebral ischemia
  • cerebrovascular diseases and cerebral circulation
  • risk factors
  • viral infections

Published Papers (5 papers)

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Research

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10 pages, 412 KiB  
Article
Intravenous Thrombolysis for Acute Ischemic Stroke during the COVID-19 Pandemic—Polish Single-Center Retrospective Cohort Study
by Tomasz Chmiela, Michalina Rzepka, Maciej Kuca, Karolina Serwońska, Maciej Laskowski, Agnieszka Koperczak and Joanna Siuda
Life 2022, 12(7), 1068; https://doi.org/10.3390/life12071068 - 17 Jul 2022
Cited by 2 | Viewed by 2006
Abstract
COVID-19 has affected the entire world and has had a great impact on healthcare, influencing the treatment of patients with acute ischemic stroke (AIS). The aim of this study was to determine the impact of the COVID-19 pandemic on the care of patients [...] Read more.
COVID-19 has affected the entire world and has had a great impact on healthcare, influencing the treatment of patients with acute ischemic stroke (AIS). The aim of this study was to determine the impact of the COVID-19 pandemic on the care of patients with AIS. We performed a retrospective analysis of 1599 patients diagnosed with AIS and hospitalized in the authors’ institution from January 2018 to December 2021. The final sample consisted of 265 patients treated with thrombolysis without a diagnosis of COVID-19. The initiation of thrombolytic treatment during the pandemic was delayed (2:42 ± 0:51 vs. 2:25 ± 0:53; p = 0.0006). The delay was mainly related to the pre-hospital phase (1:41 ± 0:48 vs. 1:26 ± 0:49; p = 0.0014), and the door-to-needle time was not affected. There were no differences in stroke severity and patients’ outcomes. Patients with AIS were less likely to have previously been diagnosed with atrial fibrillation (16.9% vs. 26.7%; p = 0.0383), ischemic heart disease (25.3% vs. 46.5%; p = 0.0003) and hyperlipidemia (31.2% vs. 46.5%; p = 0.0264). Patients treated during the pandemic had higher glycemia (149.45 ± 54. vs. 143.25 ± 60.71 mg/dL; p= 0.0012), while no significant differences in their lipid profiles were found. Conclusions: The COVID-19 pandemic affected the treatment of AIS patients locally at our stroke center. It caused treatment delay and hindered the recognition of risk factors prior to the occurrence of AIS. Full article
(This article belongs to the Special Issue Stroke and COVID-19: Pathophysiological Links, Clinical Implications and Stroke Care in Times of the Pandemic)
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11 pages, 428 KiB  
Article
Delayed Comprehensive Stroke Unit Care Attributable to the Evolution of Infection Protection Measures across Two Consecutive Waves of the COVID-19 Pandemic
by Annahita Sedghi, Timo Siepmann, Lars-Peder Pallesen, Heinz Reichmann, Volker Puetz, Jessica Barlinn and Kristian Barlinn
Life 2021, 11(7), 710; https://doi.org/10.3390/life11070710 - 19 Jul 2021
Cited by 5 | Viewed by 2047
Abstract
We aimed to assess how evidence-based stroke care changed over the two waves of the COVID-19 pandemic. We analyzed acute stroke patients admitted to a tertiary care hospital in Germany during the first (2 March 2020–9 June 2020) and second (23 September 2020–31 [...] Read more.
We aimed to assess how evidence-based stroke care changed over the two waves of the COVID-19 pandemic. We analyzed acute stroke patients admitted to a tertiary care hospital in Germany during the first (2 March 2020–9 June 2020) and second (23 September 2020–31 December 2020, 100 days each) infection waves. Stroke care performance indicators were compared among waves. A 25.2% decline of acute stroke admissions was noted during the second (n = 249) compared with the first (n = 333) wave of the pandemic. Patients were more frequently tested SARS-CoV-2 positive during the second than the first wave (11 (4.4%) vs. 0; p < 0.001). There were no differences in rates of reperfusion therapies (37% vs. 36.5%; p = 1.0) or treatment process times (p > 0.05). However, stroke unit access was more frequently delayed (17 (6.8%) vs. 5 (1.5%); p = 0.001), and hospitalization until inpatient rehabilitation was longer (20 (1, 27) vs. 12 (8, 17) days; p < 0.0001) during the second compared with the first pandemic wave. Clinical severity, stroke etiology, appropriate secondary prevention medication, and discharge disposition were comparable among both waves. Infection control measures may adversely affect access to stroke unit care and extend hospitalization, while performance indicators of hyperacute stroke care seem to be untainted. Full article
(This article belongs to the Special Issue Stroke and COVID-19: Pathophysiological Links, Clinical Implications and Stroke Care in Times of the Pandemic)
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Review

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13 pages, 1707 KiB  
Review
Cerebral Vasomotor Reactivity in COVID-19: A Narrative Review
by Zahra Ghotbi, Mehrdad Estakhr, Melika Hosseini and Reza Bavarsad Shahripour
Life 2023, 13(7), 1614; https://doi.org/10.3390/life13071614 - 24 Jul 2023
Cited by 2 | Viewed by 2138
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system but can also lead to neurological complications. Among COVID-19 patients, the endothelium is considered the Achilles heel. A variety of endothelial dysfunctions may result from SARS-CoV-2 infection and subsequent endotheliitis, such [...] Read more.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system but can also lead to neurological complications. Among COVID-19 patients, the endothelium is considered the Achilles heel. A variety of endothelial dysfunctions may result from SARS-CoV-2 infection and subsequent endotheliitis, such as altered vascular tone, oxidative stress, and cytokine storms. The cerebral hemodynamic impairment that is caused is associated with a higher probability of severe disease and poor outcomes in patients with COVID-19. This review summarizes the most relevant literature on the role of vasomotor reactivity (VMR) in COVID-19 patients. An overview of the research articles is presented. Most of the studies have supported the hypothesis that endothelial dysfunction and cerebral VMR impairment occur in COVID-19 patients. Researchers believe these alterations may be due to direct viral invasion of the brain or indirect effects, such as inflammation and cytokines. Recently, researchers have concluded that viruses such as the Human Herpes Virus 8 and the Hantavirus predominantly affect endothelial cells and, therefore, affect cerebral hemodynamics. Especially in COVID-19 patients, impaired VMR is associated with a higher risk of severe disease and poor outcomes. Using VMR, one can gain valuable insight into a patient’s disease progression and make more informed decisions regarding appropriate treatment options. A new pandemic may develop with the COVID-19 virus or other viruses, making it essential that healthcare providers and researchers remain focused on developing new strategies for improving survival in such patients, particularly those with cerebrovascular risk factors. Full article
(This article belongs to the Special Issue Stroke and COVID-19: Pathophysiological Links, Clinical Implications and Stroke Care in Times of the Pandemic)
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18 pages, 1899 KiB  
Review
Pathomechanisms and Treatment Implications for Stroke in COVID-19: A Review of the Literature
by Brian Stamm, Deborah Huang, Regina Royan, Jessica Lee, Joshua Marquez and Masoom Desai
Life 2022, 12(2), 207; https://doi.org/10.3390/life12020207 - 29 Jan 2022
Cited by 11 | Viewed by 4411
Abstract
Stroke in patients with COVID-19 has received increasing attention throughout the global COVID-19 pandemic, perhaps due to the substantial disability and mortality that can result when the two conditions co-occur. We reviewed the existing literature and found that the proposed pathomechanism underlying COVID-19-associated [...] Read more.
Stroke in patients with COVID-19 has received increasing attention throughout the global COVID-19 pandemic, perhaps due to the substantial disability and mortality that can result when the two conditions co-occur. We reviewed the existing literature and found that the proposed pathomechanism underlying COVID-19-associated ischemic stroke is broadly divided into the following three categories: vasculitis, endothelialitis, and endothelial dysfunction; hypercoagulable state; and cardioembolism secondary to cardiac dysfunction. There has been substantial debate as to whether there is a causal link between stroke and COVID-19. However, the distinct phenotype of COVID-19-associated strokes, with multivessel territory infarcts, higher proportion of large vessel occlusions, and cryptogenic stroke mechanism, that emerged in pooled analytic comparisons with non-COVID-19 strokes is compelling. Further, in this article, we review the various treatment approaches that have emerged as they relate to the proposed pathomechanisms. Finally, we briefly cover the logistical challenges, such as delays in treatment, faced by providers and health systems; the innovative approaches utilized, including the role of tele-stroke; and the future directions in COVID-19-associated stroke research and healthcare delivery. Full article
(This article belongs to the Special Issue Stroke and COVID-19: Pathophysiological Links, Clinical Implications and Stroke Care in Times of the Pandemic)
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Other

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11 pages, 1978 KiB  
Case Report
Case Report of Cerebral Sinus Thrombosis Related to Immune Thrombotic Thrombocytopenia Following Administration of ChAdOx1 nCoV-19 for Vaccination against COVID-19
by Wojciech Szypowski, Aleksander Dębiec, Jarosław Świstak, Maciej Nowocień, Piotr Rzepecki, Marcin Możański, Jacek Staszewski and Adam Stępień
Life 2022, 12(2), 168; https://doi.org/10.3390/life12020168 - 24 Jan 2022
Cited by 2 | Viewed by 7060
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous sinus thrombosis (CVST) has been recently reported after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a case of a patient with fulminant CVST and thrombocytopenia after receiving the ChAdOx1 nCoV-19 vaccine. [...] Read more.
Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous sinus thrombosis (CVST) has been recently reported after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a case of a patient with fulminant CVST and thrombocytopenia after receiving the ChAdOx1 nCoV-19 vaccine. Although the patient received immediate anticoagulant and intravenous immune globulin treatment, he died within 24 h after hospital admission. VITT and CVST are rare conditions; however, the course may be fatal. Therefore, clinicians should be familiarized with the clinical and laboratory features of VITT. Full article
(This article belongs to the Special Issue Stroke and COVID-19: Pathophysiological Links, Clinical Implications and Stroke Care in Times of the Pandemic)
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