Literature Review (Grey)
The outbreak of the novel COVID-19 caused by the SARS-CoV-2 virus has rapidly spread around the world. Increasing evidence has suggested that patients with COVID-19 may present with neurological symptoms, and cerebrovascular diseases are one of the most frequent comorbidities. The markedly elevated D-dimer levels in patients with acute ischaemic stroke suggests that SARS-CoV-2 infection may induce an inflammatory response and trigger a hypercoagulation state, thus leading to acute ischaemic stroke. Cardioembolism and atherosclerosis in patients with COVID-19 infection may also increase the risk of ischaemic stroke. The reduction of angiotensin-converting enzyme II (ACE2) caused by SARS-CoV-2 binding to the ACE2 receptor can lead to abnormally elevated blood pressure and increase the risk of haemorrhagic stroke. Additionally, the cytokine storm induced by the immune response against the viral infection increases the risk of acute stroke. The management of COVID-19 patients with stroke is not only based on the traditional guidelines, but also based on the experience and new instructions from healthcare workers worldwide who are combatting COVID-19. This review aims to summarise current evidence of the epidemiology and potential mechanisms of various cerebrovascular diseases with COVID-19 to provide clinical insight for the management of patients with stroke in the context of the COVID-19 pandemic.