Pathomechanism and Management of Stroke in COVID-19: Review of Immunopathogenesis, Coagulopathy, Endothelial Dysfunction, and Downregulation of ACE2.

Coronavirus disease 2019 (COVID-19) can reportedly manifest as an acute stroke, with most cases presenting as large vessel ischemic stroke in patients with or without comorbidities. The exact pathomechanism of stroke in COVID-19 remains ambiguous. The findings of previous studies indicate that the most likely underlying mechanisms are cerebrovascular pathological conditions following viral infection, inflammation-induced endothelial dysfunction, and hypercoagulability. Acute endothelial damage due to inflammation triggers a coagulation cascade, thrombosis propagation, and destabilization of atherosclerosis plaques, leading to large-vessel occlusion and plaque ulceration with concomitant thromboemboli, and manifests as ischemic stroke. Another possible mechanism is the downregulation of angiotensin-converting enzyme 2 as the target action of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Acute stroke management protocols need to be modified during the COVID-19 pandemic in order to adequately manage stroke patients with COVID-19.

Pain as clinical manifestations of COVID-19 infection and its management in the pandemic era: a literature review.

Coronavirus disease 2019 (COVID-19) is a current global pandemic. The case number has increased since December 31, 2019. It has been reported that COVID-19 patients have been giving pain complaints, one of which is muscular pain. Other types of pain that have also been reported by COVID-19 patients are joint pain, stomach pain, and testicular pain. Neuropathic pain is the rarest case among others. COVID-19 mechanisms in the nerve and musculoskeletal damage are believed to be caused by the expression and distribution of angiotensin-converting enzyme 2 (ACE-2). Patients with pain, especially neuropathic pain, normally do not respond well to various therapies, and experience psychiatric disorders such as depression, which leads to a decrease in the patient's quality of life. Important considerations for health professionals in terms of pain management during this pandemic include ensuring treatment continuity, painkillers, utilization of telemedicine, biopsychosocial management approach, and modifying therapy needs to reduce the risks of COVID-19 complications.