Coronavirus disease 2019 (COVID-19) predominantly affects the respiratory system. However, the viral infection has been associated with brain involvement. In the literature multiple routes are described through which this neurotrophic virus enters the central and peripheral nervous system, including direct and indirect pathways. This can cause various neurological complications, mostly in the advanced stages of the disease. In this case series we present four patients with COVID-19 and stroke out of 59 COVID-19 patients admitted to the intensive care unit in Ede, the Netherlands, before October 2020. Patients had two to five risk factors for cerebrovascular disease. In conclusion, COVID-19 itself might be a risk factor for neurological complications, particularly stroke in patients with cerebrovascular risk factors. Although the underlying pathophysiology remains to be fully understood, physicians should be aware of these neurological complications while treating critically ill patients with COVID-19.
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