tetano
Editor, Senior Moderator
Aging (Albany NY)
. 2020 Jun 11;12.
doi: 10.18632/aging.103335. Online ahead of print.
Potential Mechanisms of Hemorrhagic Stroke in Elderly COVID-19 Patients
Haili Wang[SUP] 1 2 [/SUP], Xiaojia Tang[SUP] 1 2 [/SUP], Hongyang Fan[SUP] 1 [/SUP], Yuhan Luo[SUP] 1 2 [/SUP], Yuxia Song[SUP] 1 2 [/SUP], Yao Xu[SUP] 1 [/SUP], Yingzhu Chen[SUP] 1 [/SUP]
Affiliations
Abstract
The novel severe acute respiratory syndrome coronavirus 2 is the causative agent of coronavirus disease 2019, a new human infectious disease. While fever, cough, and respiratory distress are typical first symptoms, a fraction of those affected present instead with neurological symptoms suggestive of central nervous system compromise. This review summarizes the potential contribution of coronavirus disease 2019 to hemorrhagic stroke in the elderly and proposes possible mechanisms. Reports show that the most affected patients have underlying chronic diseases such as hypertension and diabetes, which are two key risk factors for hemorrhagic stroke. Angiotensin-converting enzyme 2 is the main host cell surface receptor interacting with the severe acute respiratory syndrome coronavirus 2 spike glycoprotein to allow viral entry and infection. We speculate that ensuing downregulation of angiotensin-converting enzyme 2 expression may compound the risk conferred by pre-existing comorbidities and critically influence the pathogenesis of hemorrhagic stroke by elevating blood pressure and impairing cerebrovascular endothelial function. Additionally, both age- and/or disease-related immune dysfunction and enhanced catecholamine release secondary to anxiety and stress may also aggravate central nervous system symptoms of severe acute respiratory syndrome coronavirus 2 infection. Thus, assessment of systemic inflammatory biomarkers and tight control of hemodynamic parameters upon admission are crucial to minimize mortality and morbidity in coronavirus disease 2019 patients with central nervous system symptoms suggestive of incipient stroke.
Keywords: ACE2; COVID-19; SARS-CoV-2; hemorrhagic stroke; immunity.
. 2020 Jun 11;12.
doi: 10.18632/aging.103335. Online ahead of print.
Potential Mechanisms of Hemorrhagic Stroke in Elderly COVID-19 Patients
Haili Wang[SUP] 1 2 [/SUP], Xiaojia Tang[SUP] 1 2 [/SUP], Hongyang Fan[SUP] 1 [/SUP], Yuhan Luo[SUP] 1 2 [/SUP], Yuxia Song[SUP] 1 2 [/SUP], Yao Xu[SUP] 1 [/SUP], Yingzhu Chen[SUP] 1 [/SUP]
Affiliations
- PMID: 32527987
- DOI: 10.18632/aging.103335
Abstract
The novel severe acute respiratory syndrome coronavirus 2 is the causative agent of coronavirus disease 2019, a new human infectious disease. While fever, cough, and respiratory distress are typical first symptoms, a fraction of those affected present instead with neurological symptoms suggestive of central nervous system compromise. This review summarizes the potential contribution of coronavirus disease 2019 to hemorrhagic stroke in the elderly and proposes possible mechanisms. Reports show that the most affected patients have underlying chronic diseases such as hypertension and diabetes, which are two key risk factors for hemorrhagic stroke. Angiotensin-converting enzyme 2 is the main host cell surface receptor interacting with the severe acute respiratory syndrome coronavirus 2 spike glycoprotein to allow viral entry and infection. We speculate that ensuing downregulation of angiotensin-converting enzyme 2 expression may compound the risk conferred by pre-existing comorbidities and critically influence the pathogenesis of hemorrhagic stroke by elevating blood pressure and impairing cerebrovascular endothelial function. Additionally, both age- and/or disease-related immune dysfunction and enhanced catecholamine release secondary to anxiety and stress may also aggravate central nervous system symptoms of severe acute respiratory syndrome coronavirus 2 infection. Thus, assessment of systemic inflammatory biomarkers and tight control of hemodynamic parameters upon admission are crucial to minimize mortality and morbidity in coronavirus disease 2019 patients with central nervous system symptoms suggestive of incipient stroke.
Keywords: ACE2; COVID-19; SARS-CoV-2; hemorrhagic stroke; immunity.