Der Zusammenhang zwischen COVID-19 und Schlaganfall: Pathophysiologie und klinische Bedeutung

Zusammenfassung

Dass COVID-19 mit einem erhöhten Risiko für das Auftreten ischämischer Schlaganfälle einhergeht, wurde bereits in den ersten Monaten nach dem weltweiten Bekanntwerden des Ausbruchs der Pandemie im Ground Zero Wuhan deutlich. Spätere Kohortenanalysen, Fallserien und Meta-Analysen bestätigten diesen Zusammenhang. Eine nicht unerhebliche geographische Variabilität der Prävalenz COVID-19-bezogener Schlaganfälle verdeutlicht allerdings den fortbestehenden Bedarf an umfassenden epidemiologischen Analysen. Im Übrigen fanden sich zunehmend Hinweise dafür, dass dem mit COVID-19 assoziierten Schlaganfall ein multifaktorieller pathophysiologischer Mechanismus zugrundeliegenden könnte. Neben einer durch die SARS-CoV-2-Infektion verursachten Hyperkoagubilität, die sowohl im mikrovaskulären System als auch in Großgefäßen thrombogen wirkt, scheinen vaskulitische arterielle Veränderungen und kardiogene Embolien infolge virusassoziierter myokardialer Schädigung bei der Ätiologie des COVID-19-assoziierten Schlaganfalls eine Rolle zu spielen. Die Versorgung von Schlaganfallpatienten/innen in Zeiten der Pandemie durch multidisziplinäre Teams scheint in insgesamt kompensierten Kliniken im Wesentlichen nicht kompromittiert zu sein. Hinweise, dass Patienten/innen mit COVID-19-assoziiertem Schlaganfall von einem intensivierten Monitoring und einer aggressiveren Sekundärprävention profitieren, bedarf klinischer Prüfung.

Abstract

The notion of an increased risk of acute ischemic stroke in patients with COVID-19 emerged during the first months after the outbreak of the COVID-19 pandemic at ground zero in Wuhan. Subsequently, this association was confirmed by multiple case reports, cohort studies and meta-analyses. However, substantial geographical variability in prevalence of COVID-19 associated stroke underscores a persistent need of encompassing epidemiological study. Accumulative evidence suggested a rather complex underlying pathophysiology. Possible mechanisms include small and large vessel thromboembolism induced by systemic hypercoagubility, vasculitis and cardiac embolism caused by virus-induced cardiomyopathy. Multidisciplinary care of acute stroke patients in general does not seem to be compromised by the pandemic in otherwise compensated hospitals. However, it remains to be answered whether more aggressive approaches of secondary prevention and intensified monitoring strategies after COVID-19 related stroke are necessary to optimize clinical outcomes.

Schlüsselwörter

COVID-19 - SARS-CoV-2 - Schlaganfall - Hyperkoagulabilität - Vaskulitis - Kardiomyopathie

Key words

COVID-19 - SARS-CoV-2 - Stroke - Hypercoagulability - Vasculitis - Cardiomyopathy

Publication History

Received: 09 February 2021

Accepted: 08 April 2021

Article published online:
21 May 2021

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