American Journal Of Biomedical Science & Pharmaceutical Innovation
21
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VOLUME
Vol.05 Issue04 2025
PAGE NO.
21-23
10.37547/ajbspi/Volume05Issue04-05
Neurological Complications of Covid-19: Focus on Acute
Cerebrovascular Accidents
Shodmonov Asilbek Otabekovich
Assistant of the department of anatomy and clinical anatomy of ZARMED University, ZARMED University, Samarkand, Uzbekistan
Received:
23 February 2025;
Accepted:
19 March 2025;
Published:
22 April 2025
Abstract:
COVID-19, typically regarded as a respiratory illness, exhibits substantial neurological involvement,
especially in severely affected patients. Acute cerebrovascular events, including ischemic and hemorrhagic
strokes, are seen in relatively young, previously healthy individuals, linked to hypercoagulability and
prothrombotic states. Neurological complications of COVID-19 may arise without direct central nervous system
infection, stemming from a severe systemic reaction to the infection. Further research into the pathophysiology
and clinical trials are needed to optimize strategies preventing long-term consequences and therapeutic choices.
Keywords:
COVID-19; SARS-CoV-2; neurological complications; acute cerebrovascular accident; ischemic stroke;
cerebral haemorrhage; cerebral vein thrombosis; hypercoagulability; thrombosis.
Introduction:
Ischemic stroke remains one of the
leading causes of death and disability worldwide.
According to the Global Burden of Disease study, the
total number of disability-adjusted life years (DALYs)
due to stroke reached 143 million in 2019. Given the
aging population and the increasing number of risk
factors, the issue of long-term neurological and
functional consequences of stroke is becoming
increasingly important. Despite advances in acute
therapy, such as extending the time frame for
endovascular thrombectomy to 24 hours in selected
cases, the need for a thorough understanding and
effective management of late consequences remains a
key challenge in modern neurology and rehabilitation.
METHODS
A systematic review of the literature on the topics of
remote neurological consequences of ischemic stroke
was conducted, including epidemiological studies,
longitudinal cognitive and neuropsychological studies,
data from child and adult cohorts, as well as
international clinical guidelines of AHA/ASA, ESO and
NICE. Inclusion criteria: publications for 2000
–
2023,
English- and Russian-language articles, results of
randomized controlled trials, cohort studies and
guidelines. The search was performed in the PubMed,
Scopus and eLibrary databases.
RESULTS
In 2019, the number of DALYs due to stroke was 143
million. Stroke remains the second leading cause of
death and the third leading cause of disability
worldwide.
Prospective study data showed that dementia affects
up to 20% of patients in the acute phase and up to 39%
of survivors one year after stroke. A study by
Mehrabian et al. found that hippocampal atrophy is the
strongest predictor of late post-stroke cognitive
dysfunction.
Table 1
Prevalence of cognitive and neurological outcomes after ischemic stroke
Outcome
Group
Frequency
Dementia 1 year after stroke
Adults
39%
Moderate and severe neurological impairment 2 years later
Children
9,4%
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Incidence of recurrent MI/TIA in children
Children
19%
Movement disorders and post-stroke pain significantly
affect the quality of life and require a comprehensive
multidisciplinary
approach
to
rehabilitation.
Psychoemotional complications, such as depression
and anxiety disorders, are observed in a significant
proportion of patients. In the United States, only 30.7%
of stroke survivors received outpatient rehabilitation.
In three Korean hospitals, 27.9% of patients received
rehabilitation counseling, 12.9% were transferred to
rehabilitation departments.
Table 2
Access to rehabilitation in patients after ischemic stroke
Type of rehabilitation
Population
Percentage
Outpatient rehabilitation
Stroke Survivors
30,7%
Rehabilitation consultation
First Discharges from Three Korean
Hospitals
27,9%
Transfer to the rehabilitation
department
First Discharges from Three Korean
Hospitals
12,9%
DISCUSSION
The results of the review confirm a significant level of
cognitive and neurological impairment in the late
period after ischemic stroke in adults and children. The
high incidence of dementia and motor deficits
emphasizes the importance of early risk identification
and development of effective rehabilitation strategies.
Despite
the
proven
benefits
of
extended
thrombectomy and telestroke networks for delivery of
acute care, many patients face limited access to
rehabilitation services.
The 2018 AHA/ASA Guidelines, partially revised and
supplemented after the removal of a number of
sections, emphasize the need for an individualized
approach and multifactorial outcome assessment.
International ESO and NICE guidelines also focus on
continuous rehabilitation and monitoring of cognitive
status.
Scheme 1. Pathogenetic stages of development and remote outcomes of ischemic stroke
Acute phase of
stroke
Cerebral
ischemia: nucleus
and penumbra
Neuropsychologi
cal consequences
Cognitive
impairment and
dementia
Post-stroke pain
and emotional
disorders
Functional
independence
and quality of life
Motor and
sensory deficits
Rehabilitation
and access to
care
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
CONCLUSION
Stroke remains the leading cause of DALYs worldwide.
Dementia occurs in 39% of survivors one year after
stroke. In children, 9.4% have moderate to severe
neurological impairment at two years; recurrent
MI/TIA reaches 19%. Only 27.9% of patients receive
rehabilitation consultations and 12.9% are transferred
to rehabilitation units during their first hospitalization;
30.7% of survivors receive outpatient rehabilitation.
Extension of the time frame of endovascular
thrombectomy to 24 hours has improved access to
acute therapy. Further research should be aimed at
improving the quality and availability of rehabilitation,
developing personalized neuroprotection programs
and introducing modern technologies for monitoring
and supporting patients in the late period after stroke.
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