ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects multiple body systems, including the nervous system. Cerebrovascular accidents can also occur. Patients with comorbid illnesses have severe manifestations and poor outcomes. Despite the proper mechanism of SARS-CoV-2 infection-associated stroke having not yet been settled, various possible mechanisms have been hypothesized. One possibility is that the virus causes endothelial dysfunction and immune-mediated injury. Another possibility is that the trans-neuronal spread of the virus affects brain tissue. In addition, hypercoagulability caused by SARS-CoV-2 infection could lead to a stroke. A virus-induced dysfunction of the renin-angiotensin system could also lead to a stroke. The immune response and vasculitis resulting from SARS-CoV-2 infection are also possible causes via a cytokine storm, immune dysfunction, and various inflammatory responses. SARS-CoV-2 infection may affect calcitonin gene-related peptides and cerebral blood flow and may lead to stroke. Finally, SARS-CoV-2 may cause hemorrhagic strokes via mechanisms stimulated by its interaction with angiotensin-converting enzyme 2 (ACE2), leading to arterial wall damage and blood pressure changes. In this article, we will present seven cases of stroke-associated SARS-CoV-2 infection.
ABSTRACT
INTRODUCTION: Neurological problems may be part of severe and early course of coronavirus disease 2019 (COVID-19). COVID-19 associated encephalitis as an evident etiology of altered consciousness has been rarely reported in the literature. CASE REPORT: A case of 66-year-old female presented with classic COVID-19 symptoms and associated diabetic ketoacidosis. Although diabetic ketoacidosis was managed, the patient had persistent impaired level of consciousness with recurrent attacks of left focal fits because of COVID-19-associated encephalitis. However, the patient has markedly improved after recovering from COVID-19. CONCLUSION: Neurologists should be involved in the evaluation and management of COVID-19 patients who present with associated neurological problems.