Update on cerebrovascular manifestations of COVID-19
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COVID-19
Update on cerebrovascular manifestations of COVID-19 Reza Naeimi 1 & Maryam Ghasemi–Kasman 2,3 Received: 30 August 2020 / Accepted: 15 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract The novel member of coronaviruses family, severe acute respiratory coronavirus-2 (SARS-CoV-2), with high structural homology to SARS-CoV and Middle East respiratory syndrome-related coronavirus (MERS) has spread rapidly with about 20 million cases infection and over 700,000 deaths. SARS-CoV-2 has been emerged as a worldwide disaster due to non-specific few respiratory and gastrointestinal manifestations at the onset of disease as well as long incubation period. Surprisingly, not only respiratory failure but also the underlying coagulation disorder and neurovascular involvement worsen the clinical outcome of infected patients. In this review article, we describe the probable mechanisms of SARS-CoV-2 infection and stroke occurrence. We will also discuss the cerebrovascular events following SARS-CoV-2 infection, the recommended therapies, and future prospects to better manage these patients in coronavirus disease 2019 (COVID-19) outbreak. Keywords Coronavirus . SARS-CoV-2 . COVID-19 . Coagulation . Stroke . Anticoagulative therapies
Introduction The novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome 2 (SARS-CoV-2) has initially originated from Wuhan city of China in December 2019 with suspicious unusual pneumonia symptoms [1]. The World Health Organization (WHO) declared it a pandemic on 11 March 2020 [2]. SARS-CoV-2 is an enveloped β-type novel coronavirus with a single-strand, positive-sense RNA genome consisting of 29,000 nucleotide bases in length [3]. On the basis of latest recognized SARS-CoV-2 pathogenesis, this four-part virus (the envelope, membrane, spike, and nucleocapsid protein) invades the cells through the spike protein binding to angiotensin converting enzyme 2 (ACE2) [4]. ACE2 is a widespread distributed receptor on the cellular surface of multiple organs including endothelial and neural cells [4]. COVID-19 is mainly transmitted through respiratory
* Maryam Ghasemi–Kasman [email protected]; [email protected] 1
Student Research Committee, Babol University of Medical Sciences, Babol, Iran
2
Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
3
Neuroscience Research Center, Health Research Institute, Babol University of Medical Sciences, P.O. Box 4136747176, Babol, Iran
droplets and contact, stool, and prolonged exposure to aerosols in a closed environment with incubation period from 3 to even 38 days in some cases [3]. The most constitutional symptoms at the onset of disease consists of fever, dry cough, shortness of breath, sore throat, fatigue, malaise, diarrhea, dyspnea, headache, pneumonia, acute respiratory distress syndrome (ARDS), and multiorgan dysfunction [5]. Although most patients with COVID-19 have mild-to-moderate constitutional symptoms, approximately 15% experie
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