**2. Impact of COVID-19**

The COVID-19 infection has already created enough havoc and commotion around the globe. Depending on the infection's severity and the amount of its dissemination, the effect may differ. To treat the weak and limit the spread of disease, however, the entire world returned with a range of strategies. Isolation, quarantine, and lockdowns have impacted the lives of millions of people, which has had a negative impact on the economy and general well-being [1, 2]. Critically ill patients and COVID-19 survivors are more likely to have preexisting disorders that make them disabled, including functional, social, and mental or psychological side effects from severe illness. This includes a typically gradual recovery that lowers overall quality of life [3].

Cerebrovascular events (CVE) were one of the COVID-19 infection's many postinfection consequences that were of major importance [4]. A significant COVID-19 disease consequence is still acute ischemic stroke. Even if there are more reports of these situations, it is still unclear what the underlying mechanisms are [5]. The incidence of acute ischemic stroke (AIS) linked to severe COVID-19 is rising quickly. Currently, research is being done on the underlying pathophysiological pathways linked to peripheral and central inflammation that cause ischemic strokes linked to COVID-19. The angiotensin-converting enzyme 2 (ACE2) receptors on epithelial and endothelial cells are known to bind to SARS-CoV2, and this binding results in hypercoagulability, clot formation, and ultimately AIS [6]. Systemic immunity-mediated hyperinflammation, endothelitis, deregulation of the renin-angiotensin-aldosterone system (RAAS) in the central nervous system, oxidative stress, and excessive platelet aggregation are some of the main mechanisms that have been proposed so far [7–9]. According to other research, the inflammatory reactions to COVID-19 may cause a previously identified atheroma to rupture, which could result in thrombosis and ischemic stroke [10]. However, the rising reports of ischemic strokes linked to COVID-19 infections may be a symptom of this disease's hypercoagulable spectrum. One of the numerous post sequelae problems, post-COVID-19 stroke, has resulted from this and is now progressing.

According to a preliminary retrospective case series investigation from Wuhan, China, acute CVE was the cause in 5.7% of cases with neurological involvement [4]. Following the outbreak, many homes and facilities were quarantined and isolated. As a result, a lot of people spent a lot of time stuck at home or in facilities, which led to inactivity. One of the research projects [11, 12] suggested that this physical

#### *Post-COVID Stroke and Rehabilitation: A Rising Concern DOI: http://dx.doi.org/10.5772/intechopen.110543*

inactivity may have increased the risk of a subsequent stroke. 5.88% of patients with new onset CVE were discovered in another recent publication from the same center that examined 221 individuals [13]. Additionally, occurrences of ischemic stroke with no obvious risk factors as the presenting symptom have been described in COVID-19 patients who are not severely unwell [14]. This may bring attention to the variety of COVID-19 ischemic strokes. Additionally, there may have been additional risk factors for the stroke, such as diabetes and high blood pressure. It is unclear, nevertheless, if those traditional risk factors put people at an increased risk of having ischemic episodes after contracting COVID-19. The middle cerebral or posterior cerebral arteries had anterior circulation big artery infarctions in the majority of published cases [15]. Additionally, reports of multifocal strokes in severely unwell individuals are emerging [16]. Therefore, a thorough analysis and understanding of the elevated thrombotic risk in this sensitive population are crucial.
