Literature Review (Grey)
Clinical reports of neurological manifestations associated with COVID-19, such as acute ischaemic stroke (AIS), encephalopathy, seizures, headaches, acute necrotising encephalitis, cerebral microbleeds, posterior reversible leukoencephalopathy syndrome, haemophagocytic lymphohistiocytosis, peripheral neuropathy, cranial nerve palsies, transverse myelitis, and demyelinating disorders, are increasing rapidly. However, there are comparatively few studies investigating the potential impact of immunological responses secondary to hypoxia, oxidative stress, and excessive platelet-induced aggregation on the brain. This scoping review focused on the pathophysiological mechanisms associated with peripheral and consequential neural (central) inflammation leading to COVID-19-related ischaemic strokes. It also highlights the common biological processes shared between AIS and COVID-19 infection and the importance of the recognition that severe respiratory dysfunction and neurological impairments associated with COVID and chronic inflammation [post-COVID-19 neurological syndrome (PCNS)] may significantly impact recovery and ability to benefit from neurorehabilitation. This comprehensive review of the pathobiology of COVID-19 and ischaemic stroke also affirms that the immunological contribution to the pathophysiology of COVID-19 is predictive of the neurological sequelae, particularly ischaemic stroke, and argues that this makes it an expectation rather than an exception.