Potential mechanisms of hemorrhagic stroke in elderly COVID-19 patients
Open accessAbstract
The novel severe acute respiratory syndrome coronavirus 2 is the causative agent of coronavirus disease 2019, a new human infectious disease. While fever, cough, and respiratory distress are typical first symptoms, a fraction of those affected present instead with neurological symptoms suggestive of central nervous system compromise. This review summarizes the potential contribution of coronavirus disease 2019 to hemorrhagic stroke in the elderly and proposes possible mechanisms. Reports show that the most affected patients have underlying chronic diseases such as hypertension and diabetes, which are two key risk factors for hemorrhagic stroke. Angiotensin-converting enzyme 2 is the main host cell surface receptor interacting with the severe acute respiratory syndrome coronavirus 2 spike glycoprotein to allow viral entry and infection. We speculate that ensuing downregulation of angiotensin-converting enzyme 2 expression may compound the risk conferred by pre-existing comorbidities and critically influence the pathogenesis of hemorrhagic stroke by elevating blood pressure and impairing cerebrovascular endothelial function. Additionally, both age- and/or disease-related immune dysfunction and enhanced catecholamine release secondary to anxiety and stress may also aggravate central nervous system symptoms of severe acute respiratory syndrome coronavirus 2 infection. Thus, assessment of systemic inflammatory biomarkers and tight control of hemodynamic parameters upon admission are crucial to minimize mortality and morbidity in coronavirus disease 2019 patients with central nervous system symptoms suggestive of incipient stroke.
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Diverse hospitals reported increasing levels of patients affected by stroke during SARS-CoV-2 infection.
“Diverse hospitals reported increasing levels of patients affected by stroke during SARS-CoV-2 infection [129, 130].”
From Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology (2021) · cites this paper as [130]
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- Authors
- Wang, H., Tang, X., Fan, H., Luo, Y., Song, Y., Xu, Y., & Chen, Y.
- Affiliations
- Dalian Medical University (CN)
- Yangzhou University (CN)
- Corresponding author
- Chen, Yingzhu
- Venue
- Aging
- Publisher
- Impact Journals, LLC
- Published
- 2020-06-11
- Volume
- 12
- Issue
- 11
- Pages
- 10022-10034
- ISSN
- 1945-4589 (ISSN-L)
- PMC
- PMC7346040
- OpenAlex
- W3035555318
- Cited by
- 69
- References
- 102
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 10 · 2023: 9 · 2022: 22 · 2021: 16 · 2020: 9
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Aging (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Government of Jiangsu Province
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Keywords
- COVID-19 pandemic, SARS-CoV-2, hemorrhagic stroke, elderly patients, angiotensin-converting enzyme 2, ACE2 downregulation, hypertension, diabetes mellitus, immune dysfunction, catecholamine release, stress and anxiety, systemic inflammatory markers, hemodynamic management, neurological symptoms
- MeSH terms
- COVID-19, Aged, Animals, Cerebral Hemorrhage, Humans, Pneumonia, Viral, Risk Factors, Coronavirus Infections, Stroke, Pandemics
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