Acute Viral Illnesses and Ischemic Stroke: Pathophysiological Considerations in the Era of the COVID-19 Pandemic

Stroke. 2021 May;52(5):1885-1894. doi: 10.1161/STROKEAHA.120.030630. Epub 2021 Apr 2.

Abstract

The severe acute respiratory syndrome coronavirus 2 or coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the correlation with this viral illness and increased risk of stroke. Although it is too early in the pandemic to know the strength of the association between COVID-19 and stroke, it is an opportune time to review the relationship between acute viral illnesses and stroke. Here, we summarize pathophysiological principles and available literature to guide understanding of how viruses may contribute to ischemic stroke. After a review of inflammatory mechanisms, we summarize relevant pathophysiological principles of vasculopathy, hypercoagulability, and hemodynamic instability. We will end by discussing mechanisms by which several well-known viruses may cause stroke in an effort to inform our understanding of the relationship between COVID-19 and stroke.

Keywords: coronavirus; ischemic stroke; pandemic; syndrome; viruses.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Blood Coagulation
  • Brain Ischemia / complications*
  • Brain Ischemia / physiopathology*
  • Brain Ischemia / virology
  • COVID-19 / complications*
  • COVID-19 / epidemiology*
  • Hemodynamics
  • Herpesvirus 3, Human
  • Humans
  • Inflammation / physiopathology
  • Ischemic Stroke / complications*
  • Ischemic Stroke / physiopathology*
  • Ischemic Stroke / virology
  • Pandemics
  • Plaque, Atherosclerotic / physiopathology
  • Risk
  • Thrombophilia / physiopathology
  • Thrombosis / physiopathology
  • Vascular Diseases / physiopathology
  • Virus Diseases / physiopathology