脑血管意外与SARS-CoV-19（COVID-19）的系统评价

阿米拉·阿塔纳西奥斯一号、艾薇·戴利一号、安吉利·帕特尔二号、奥卢·奥耶桑米一号、德赛三号、约翰纳森·弗伦齐一号

隶属关系

PMID:34352787内政部：10.1159/000517403

摘要

背景：尽管据报道，受SARS-CoV-2影响的患者最常见的神经症状是头痛、头晕、肌痛、精神错乱和嗅觉缺失，但在SARS-CoV-2感染的背景下，已发表的同行评审病例报告中风的基础越来越广。同行评审的文献表明，在新冠病毒-19感染的情况下，脑血管意外（CVA）的风险增加。

方法：我们搜索了3个数据库（PubMed、MEDLINE和CINAHL），搜索词包括新冠病毒、新冠病毒、中风和脑血管意外。包括从2020年1月1日至9月1日发表的病例系列和病例研究，这些病例和研究均显示患者对新冠病毒-19和CVA呈阳性反应。完成数据收集和分析，并评估偏差风险。

结果：检索发现了7个县的28项研究，包括73名患者。在因新冠病毒感染和CVA住院的患者中，平均年龄为60岁；最常见的既往疾病是高血压和糖尿病，那些既往无疾病的患者明显年轻，平均年龄为47岁。在患有新冠病毒-19和CVA的住院患者中，大多数患者被分为轻度或严重的COVID-19感染，与COVID-19感染的严重程度存在双峰关联。

讨论：数据表明SARS-CoV-2是发生中风的危险因素，尤其是在高血压和糖尿病患者中。此外，SARS-CoV-2患者，尤其是那些既往无可识别疾病的患者，其卒中平均年龄较低，这使得人们高度怀疑SARS-CoV-2是卒中发生的独立危险因素；然而，如果没有可比的对照人群，这一点还无法证明。数据表明，在新冠病毒-19感染的情况下发生CVA的风险并不取决于疾病的严重程度。必须继续进行研究，以了解新冠病毒-19感染和中风的流行病学因素以及新冠病毒相关高凝状态的病理生理学。

关键词：新冠病毒-19；脑血管病发作；冠状病毒；(打、击等的)一下

Eur Neurol

. 2021 Aug 5;1-8.
doi: 10.1159/000517403. Online ahead of print.
Cerebrovascular Accident and SARS-CoV-19 (COVID-19): A Systematic Review
Amira Athanasios  1 , Ivy Daley  1 , Anjali Patel  2 , Olu Oyesanmi  1 , Parth Desai  3 , Johnathan Frunzi  1
Affiliations

   PMID: 34352787 DOI: 10.1159/000517403

Abstract

Background: While the most common neurologic symptoms reported in patients affected by SARS-CoV-2 are headache, dizziness, myalgia, mental fog, and anosmia, there is a growing basis of published peer-reviewed cases reporting stroke in the setting of SARS-CoV-2 infection. The peer-reviewed literature suggests an increased risk of cerebrovascular accident (CVA) in the setting of COVID-19 infection.

Methods: We searched 3 databases (PubMed, MEDLINE, and CINAHL) with search terms COVID-19, novel coronavirus, stroke, and cerebrovascular accident. Case series and case studies presenting patients positive for both COVID-19 and CVA published from January 1 through September 1, 2020, were included. Data collection and analysis was completed and risk of bias assessed.

Results: The search identified 28 studies across 7 counties comprising 73 patients. Amongst patients hospitalized for COVID-19 infection and CVA, the average age was 60; the most common preexisting conditions were hypertension and diabetes mellitus, and those without preexisting conditions were significantly younger with an average age of 47. Amongst hospitalized patients with COVID-19 and CVA, there was a bimodal association with COVID-19 infection severity with majority of patients classified with mild or critical COVID-19 infection.

Discussion: The data suggest SARS-CoV-2 is a risk factor for developing stroke, particularly in patients with hypertension and diabetes. Furthermore, the younger average age of stroke in patients with SARS-CoV-2, particularly those patients with zero identifiable preexisting conditions, creates high suspicion that SARS-CoV-2 is an independent risk factor for development of stroke; however, this cannot yet be proven without comparable control population. The data suggest the risk of developing CVA in the setting of COVID-19 infection is not dependent upon severity of illness. Continued studies must be done to understand the epidemiologic factors of COVID-19 infection and stroke and the pathophysiology of the COVID-associated hypercoagulable state.

Keywords: COVID-19; Cerebrovascular attack; Coronavirus; Stroke.