Covid-19 and stroke: From the cases to the causes

Giovanni Frisullo, Irene Scala, Simone Bellavia, Aldobrando Broccolini, Valerio Brunetti, Roberta Morosetti, Giacomo Della Marca, Paolo Calabresi

Research output: Contribution to journalArticlepeer-review


During COVID-19 pandemic, a wide variety of stroke typologies have been described in patients affected by SARS-CoV-2. Investigating the case reports of acute stroke in COVID-19 patients, published since the beginning of the pandemic, we tried to trace the pathogenic mechanisms of stroke during SARS-CoV-2 infection. We conducted a systematic review analyzing demographic data, cerebrovascular risk factors, NIHSS score, vascular territory involvement and laboratory findings of 168 patients described in 89 studies, from a pool of 1243 records. Based on our results, we have identified different stroke profiles: (1) cerebral large vessel disease (CLVD) profile with a low disability, simultaneous onset of COVID-19 and stroke symptoms, good outcome and low serum levels of D-dimer and CRP; (2) intracranial bleeding (IB) profile with high disability, poor outcome and low levels of serum markers of inflammation and coagulopathy; (3) CLVD profile with a short time-lapse between COVID-19 symptoms and stroke onset, high neurological disability and very high systemic inflammatory markers; (4) multiple thrombo-embolic disease (MTED) profile with older patients, many comorbidities, disabling stroke, poor outcome, evident alteration of coagulation tests and high serum levels of both D-dimer and CRP. We therefore summarized these different profiles in a spectrum similar to that of visible light, where the violet-blue band included IB and CSVD with low inflammation and prothrombotic activity, the green-yellow band included CLVD with high inflammation and moderate prothrombotic activity and the orange-red band for MTED with moderate-high levels of inflammation and very high prothrombotic activity.

Original languageEnglish
Pages (from-to)659-669
Number of pages11
JournalReviews in the Neurosciences
Issue number6
Publication statusPublished - Aug 1 2021


  • Covid-19
  • D-dimer
  • Intracranial bleeding
  • Sars-cov-2
  • Small vessel
  • Stroke

ASJC Scopus subject areas

  • Neuroscience(all)


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