COVID-19-associated stroke risk: Could nutrition and dietary patterns have a contributing role?

Table 1 Summary of available evidence-based associations between stroke and coronavirus disease 2019

Ref.	Study design	Sample/ Aim	Main culprits suggested in the occurrence of stroke result from COVID-19 affliction
Bhaskar et al[26]	REPROGRAM consortium position paper	An overview of cytokine storm and its implications in COVID-19	(1) Cytokine storm; (2) Thromboembolic events; and (3) Large vessel occlusion
Rothstein et al[31]	Retrospective, observational study	844 COVID-19 patients, 28 of them had a stroke	(1) Endothelialitis; (2) Diffuse endothelial inflammation; (3) Infection-induced hypercoagulability; (4) Viral cardiomyopathy; and (5) Diffuse hyperinflammatory state
Valderrama et al[8]	Case study	A 52-year-old man with co-occurrence of stroke and COVID-19 infection	(1) Inflammation; (2) Injury to the myocardium; (3) Thrombogenesis; (4) Increased D-dimer levels; (5) Increased interleukin-6 levels; (6) Hyperviscosity; (7) Vascular endothelial damage; (8) Intracerebral hemorrhage; (9) Microthrombosis; and (10) Fibrinogen consumption coagulopathy
Tan et al[6]	Systematic review and meta-summary of the literature	A total of 39 studies comprising 135 patients, pooled incidence of co-occurrence of stroke and COVID-19 was 1.2%	(1) Elevated D-dimer; (2) Elevated fibrinogen; and (3) Presence of antiphospholipid antibodies
Wang et al[9]	Review article	Summarizing the potential contribution of COVID-19 to hemorrhagic stroke in the elderly and proposing possible mechanisms	(1) Downregulation of ACE2 expression; (2) Increased angiotensin II availability; (3) Severe blood pressure fluctuations; (4) Predisposition to hemorrhagic stroke; (5) Elevated plasma D-dimer levels; (6) Classical inflammatory biomarkers; (7) Viral CNS infections; (8) Cytokine, chemokine, and protease; and (9) Increasing BBB permeability
Ntaios et al[35]	Special report	Pooled all patients who were hospitalized with confirmed COVID-19 and AIS in 28 sites from 16 countries	(1) Endotheliopathy; (2) Potentiate the prothrombotic milieu; (3) Immune-mediated platelet activation; (4) Dehydration; and (5) Infection-induced cardiac arrhythmias

ACE2: Angiotensin-converting enzyme 2; AIS: Acute ischemic stroke; BBB: Blood-brain barrier; CNS: Central nervous system; COVID-19: Coronavirus disease 2019.