Coronavirus: A trigger for stroke?
Still, the number of infections with the new Coronavirus, SARS-CoV2 is on the rise. Not all people infected with the pathogen, show symptoms. In some patients mild symptoms only occur, however, severe courses of disease. In addition, there is evidence that the Virus can also cause other diseases, possibly even a stroke.
According to experts, the most common symptoms of Coronavirus disease (COVID-19) fever, fatigue, and dry cough are. Most people recover without the need for a special treatment. In rarer cases, the disease takes a severe course. In addition, researchers have found at the end of frequently neurological complaints at COVID-19. And some of the Infected had also suffered a stroke.
Severe courses of the disease with neurological symptoms
According to a statement by the German society of neurology e. V. (DGN) showed in a recent study from Wuhan is 40 of 88 patients with severe COVID-19-gradients neurological symptoms. According to the figures, five of them had suffered a stroke.
Whether the cerebrovascular events are a consequence of a direct Infection or in the severely ill COVID-19-Concerned to occur more frequently, because they have the disease usually is more stroke-favourable companion, needs to be further investigated.
The DGN stresses that COVID-19 strictly neurological Expertise is in demand.
Several patients suffered a stroke
The evaluation from China, which was published in the journal JAMA Neurology, shows that neurological manifestations in hospitalized COVID-19-patients are quite often.
Overall, neurological symptoms occurred in 36.4 percent of the total of 214 patients. It was noticeable, moreover, that neurological symptoms occurred in individuals with severe respiratory paths is increased.
The Rate of fraud in this subgroup, even 45.5 per cent (40 of 88 patients with a severe course had neurological symptoms).
According to the DGN it came to be in this group but are not heaping, but also to more severe neurological manifestations: Four patients suffered an ischemic stroke, a Patient has a hemorrhagic in 13 patients consciousness had been disturbances documented and in the case of a seizure.
Neural route of infection detected
From the authors of the accompanying neurological symptoms is explained by the fact that SARS-CoV-2 can penetrate, such as the already well-known corona viruses SARS and MERS in the Central nervous system (CNS) or in the brain, in particular in the brain stem, such as the end of February, a publication in the “Journal of Medical Virology” suggested.
The neural route of infection could animal be experimentally demonstrated, he runs from the nasal mucosa via the so-called free nerve endings to the brain.
This would also explain the extremely high frequency of loss of sense of taste and smell at COVID – 19-disease, which is estimated in a recent European study of 85.6% and 88%.
Lowered Immune System
The DGFN that were evaluated in the present study from the Wuhan laboratory parameters of the hard-hit COVID-19-patients. It was noticeable that those Affected were neurological symptoms, a lower Lymphocyte count, suggesting a reduced immune response.
In addition, they had lower Platelet and higher blood urea nitrogen levels (BUN). In addition, the group of patients with severe respiratory showed gradients overall, higher D-Dimer levels.
“D-dimers increase with Sepsis, but can also point to an activation of the coagulation system, as with other severe viral infections known. SARS-CoV-2 could promote strokes,“ explains Professor Dr. Götz Thomalla, Hamburg, spokesman for the DGN Commission Cerebrovascular disease.
“It is interesting to note that in the case of Myopathies in the context of the SARS infection histologically a vasculitis has been demonstrated. In the case of the high affinity also for the current agent to the AT 2 Receptor vasculitis appear as a cause for Stroke is conceivable,“ adds Professor Peter Berlit, Secretary-General of the DGN.
May not be a direct infection a result of
The increased stroke rate in patients with severe COVID-19-diseases is also the subject of the accompanying Editorials in the journal “JAMA Neurology”.
The editors highlight the fact that it is mostly multi-morbid patients with cardiovascular risk factors such as high blood pressure, the disease is difficult to COVID-19. Thus, the higher stroke could rate a selection bias due and there is no direct infection to be the consequence.
“Whether a stroke is now a direct consequence of the severe SARS-CoV-2 infection or a result of the fact that patients with severe Covid-19-gradients at the same time cerebrovascular risk patients, is an important research question that we have to pursue in a targeted manner. Important currently, but that strokes are recognized even in ventilated patients in a timely manner and treated,“ says Berlit.
Further investigation is needed
The Editorial authors also examine the neurological involvement in COVID-19 more, but even now have enough information to evaluate the role of the neurologist in the context of SARS-CoV-2 new, and at the `Front in the fight against the pandemic to be settled.
“In fact, it is so, that to us almost daily, new data on neurological symptoms associated with Covid-19-reach patients and the high percentage of these symptoms, sometimes the signs are also Occur without any airway involvement, the fact that Covid-19 is not a purely pneumo-logical disease, but not necessarily neurological Expertise is in demand,” says Berlit.
“Neurology is an integral part of the supply of Covid-19-patients, therefore,” says the expert. (ad)