Stroke and COVID‑19

The incidence of all acute cerebrovascular events in COVID-19 patients ranges between 0.2 and 1.3 %, while ischemic stroke (IS) is more common – 1.1 %, the proportion of hemorrhagic stroke is about 0.2 %. The presence of COVID-19 is associated with 3.58 times increased risk of IS and 5.60 times risk of in-hospital mortality. COVID-19 infection increases the risk of different subtypes of IS, especially cryptogenic stroke, which is characterized by the most severe course. The pathogenesis of stroke in COVID-19 is complex and includes a number of pathophysiological mechanisms: coagulopathy, thromboembolism, vasculitis, direct neuronal damage. The main pathophysiological mechanisms in COVID-19 stroke are yet to be established and need further investigation. Strokes in patients with COVID-19 are often characterized by a more severe course and high mortality. The stroke onset in COVID-19 patients is relatively common in younger age groups and in people without any traditional stroke risk factors. Due to the coagulopathy in COVID-19, the effectiveness of reperfusion therapy (thrombolysis and thromboextraction) is potentially reduced. Thus, early initiation of secondary prevention and active rehabilitation, which includes the drugs with cytoprotective and neuroprotective properties, are needed. When choosing a specific neuroprotective drug, special attention should be paid to the drug’s evidence base confirming its efficacy and safety, especially in stroke, it is equally important that the drug has a multimodal mechanism of action to affect the maximum possible diverse pathophysiological mechanisms of stroke development in patients with COVID-19. Citicoline appears to be a promising drug for stroke patients with COVID-19, since its effectiveness in acute ischemia is due to several mechanisms of action, in addition, the drug has a large evidence base in the treatment of stroke.