背景：已报道COVID-19患者发生缺血性卒中，特别是在更严重的病例中。然而,目前尚不清楚这在多大程度上与全身性炎症和继发于感染的高凝状态有关.
方法：我们描述了在我们医院就诊的4例缺血性卒中和COVID-19患者的病例。根据高凝状态和缺血性中风之间因果关系的可能性对患者进行分类。我们还对这些患者缺血性卒中的病因可能机制进行了综述。
结果：在2例患者中，COVID-19与卒中之间的关联可能是因果关系，出现皮质梗塞，没有相关的动脉或心脏栓塞疾病，但在实验室分析中确实显示出高凝和全身性炎症的迹象。其他2例患者高龄，出现心源性缺血性卒中；这些患者的关联可能是偶然的。
结论：系统性炎症和病毒的潜在直接作用可能导致内皮功能障碍，导致高凝状态，可被认为是缺血性卒中的潜在原因。然而,卒中涉及多种病理生理机制;因此需要更大样本的研究来证实我们的假设.中风和COVID-19患者的治疗方案应包括完整的病因研究，始终遵守适当的安全预防措施。
BACKGROUND: Ischaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection.
METHODS: We describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients.
RESULTS: The association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental.
CONCLUSIONS: Systemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.
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