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Noble O, Sprung K, Diaz O, Coulter S, Hernandez-Vila E. Spontaneous Right Intrapetrous Internal Carotid Dissection in a Patient With Active COVID-19. Tex Heart Inst J 2024; 51:e248403. [PMID: 39051844 DOI: 10.14503/thij-24-8403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Spontaneous cervical artery dissection, a nontraumatic tear in the wall of an internal carotid or vertebral artery, is a common cause of stroke, particularly in patients younger than 40 years of age; however, petrous internal carotid artery dissection is extremely rare. This case report describes a 50-year-old woman who had a spontaneous intrapetrous internal carotid dissection thought to be secondary to active SARS-CoV-2 infection; the dissection was treated successfully with a flow-diverter stent.
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Affiliation(s)
- Oscar Noble
- Tecnológico de Monterrey, School of Medicine and Health Science, Monterrey, Nuevo Leon, México
| | - Keri Sprung
- Center for Women's Heart and Vascular Health, The Texas Heart Institute, Houston, Texas
| | - Orlando Diaz
- Diagnostic Radiology, Houston Methodist Hospital, Houston, Texas
| | - Stephanie Coulter
- Center for Women's Heart and Vascular Health, The Texas Heart Institute, Houston, Texas
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2
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Pantbalekundri N, Gaidhane SA, Malali S, Nelakuditi M. Spontaneous Bilateral Vertebral Artery Dissection as a Rare Cause of Posterior Circulation Stroke in a Young Patient. Cureus 2024; 16:e65738. [PMID: 39211633 PMCID: PMC11360667 DOI: 10.7759/cureus.65738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
In young patients, ischemic stroke is an uncommon result of vertebral artery dissection (VAD). Damage to the vertebrae can occur suddenly or as a result of trauma. There are no generally recognized recommendations for diagnosis and treatment, and the majority of vague symptoms and delayed presentation provide a significant diagnostic problem. While medical management with anticoagulant or antiplatelet therapy is advised, no successful dual therapy has been documented. Although traumatic dissection is a more frequent cause of posterior cerebral circulation stroke in people under 45 years of age than spontaneous dissection, spontaneous VAD is well-reported and usually treated with anticoagulation. VAD can result in fatal complications such as basilar area infarction, even though it is often asymptomatic. Here is a case of a 37-year-old male who presented with a posterior circulation stroke after bilateral VAD with no evidence of trauma to the neck and no detectable cause suggesting spontaneous etiology.
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Affiliation(s)
- Nikhil Pantbalekundri
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Shilpa A Gaidhane
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Suprit Malali
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Manikanta Nelakuditi
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
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3
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Wittenberg B, Ryan M, Hoffman J, Bernard T, Seinfeld J, Wilkinson C. Rapidly Progressive Contralateral Internal Carotid Artery Stenosis After COVID-19 Infection in a Down Syndrome Patient With Unilateral Moyamoya Arteriopathy. Cureus 2024; 16:e56575. [PMID: 38646238 PMCID: PMC11031128 DOI: 10.7759/cureus.56575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Moyamoya arteriopathy is a condition where chronic, progressive stenosis of large intracranial arteries, primarily of the anterior circulation, results in ischemia and the growth of small, abnormal collateral vessels. There is increasing evidence that infectious pathologies, such as COVID-19, may serve as a sort of trigger, or "second hit," for the development of moyamoya arteriopathy. In this article, we present the case of a 13-year-old female with Down syndrome and unilateral moyamoya arteriopathy who developed contralateral internal carotid artery (ICA) dissection and thrombus in the setting of a positive COVID-19 test and subsequently developed rapidly progressive contralateral ICA and bilateral anterior cerebral artery (ACA) moyamoya-like stenosis. The rapidly progressive contralateral ICA and bilateral ACA moyamoya-like stenosis are likely multifactorial in nature. The contralateral ICA may have had a predisposition for injury and stenosis due to the preexisting moyamoya arteriopathy, making stenosis more likely after COVID-19-induced vascular inflammation and injury as well as after a possible thrombectomy-associated injury. Based on this presentation, patients with moyamoya arteriopathy may be at risk for rapid progression of their moyamoya pathology when exposed to catalysts, including infection, such as COVID-19, and vascular injury, such as thrombectomy-induced injury. In these circumstances, high suspicion and close monitoring are essential for addressing ischemia related to the stenosis before permanent injury.
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Affiliation(s)
- Blake Wittenberg
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Megan Ryan
- Neurosurgery, Rocky Vista University College of Osteopathic Medicine, Parker, USA
| | - Jessa Hoffman
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Timothy Bernard
- Neurology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Joshua Seinfeld
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Corbett Wilkinson
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
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4
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Sousa ÍAD, Santos Neto EPD, Corrêa MR, Veras ADO, Pontes-Neto OM. Reversible cerebral vasoconstriction syndrome related to extracranial dissection associated with COVID-19: an immunological trigger? EINSTEIN-SAO PAULO 2023; 21:eAI0445. [PMID: 37970948 DOI: 10.31744/einstein_journal/2023ai0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/14/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Ícaro Araújo de Sousa
- Department of Neuroscience and Behavior Sciences, Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brazil
| | - Elizeu Pereira Dos Santos Neto
- Institute of Radiology, Hospital das Clínicas , Faculdade de Medicina , Universidade de São Paulo , São Paulo SP , Brazil
| | - Matheus Rodrigues Corrêa
- Department of Neurology , Faculdade de Medicina , Universidade Federal do Piauí , Teresina , PI , Brazil
| | - Arthur de Oliveira Veras
- Department of Neuroscience and Behavior Sciences, Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior Sciences, Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brazil
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5
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Trager RJ, Cupler ZA, Theodorou EC, Dusek JA. COVID-19 Does Not Increase the Risk of Spontaneous Cervical Artery Dissection. Cureus 2023; 15:e47524. [PMID: 38022016 PMCID: PMC10664733 DOI: 10.7759/cureus.47524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Case reports have raised the possibility of an association between coronavirus disease 2019 (COVID-19) and spontaneous cervical artery dissection (sCeAD), yet no large studies have examined this association. We hypothesized that adults with confirmed COVID-19 would have an increased risk of sCeAD over the subsequent six months compared to test-negative controls after adjusting for confounding variables. Methods We obtained data from a United States medical records network (TriNetX, Inc., Cambridge, MA) of >106 million patients, providing adequate power needed for this rare outcome. We identified two cohorts of adults meeting the criteria of (1) test-confirmed COVID-19 or (2) non-COVID-19 test-negative controls, from April 1, 2020, to December 31, 2022. Patients with previous COVID-19 or conditions predisposing to sCeAD were excluded. Propensity matching was used to control for variables associated with sCeAD and markers of healthcare utilization. Results The number of patients reduced from before matching (COVID-19: 491,592; non-COVID-19: 1,472,895) to after matching, resulting in 491,115 patients per cohort. After matching, there were 22 cases of sCeAD in the COVID-19 cohort (0.0045%) and 20 cases in the non-COVID-19 cohort (0.0041%), yielding a risk ratio of 1.10 (95% CI: 0.60-2.02; P = 0.7576). Both cohorts had a median of five healthcare visits during follow-up. Conclusions Our results suggest that COVID-19 is not a risk factor for sCeAD. This null finding alleviates the concern raised by initial case reports and may better direct future research efforts on this topic.
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Affiliation(s)
- Robert J Trager
- Department of Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, USA
- Department of Biostatistics and Bioinformatics, Clinical Research Training Program, Duke University School of Medicine, Durham, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA (Veterans Affairs) Health Care System, Butler, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Elainie C Theodorou
- Science Research and Engineering Program, Hathaway Brown School, Cleveland, USA
| | - Jeffery A Dusek
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, USA
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6
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Kukulski L, Scharf G, Schierling W, Pfister K, Linnemann B. Spontaneous dissection of the superior mesenteric artery related to COVID-19. VASA 2023; 52:107-118. [PMID: 36636830 DOI: 10.1024/0301-1526/a001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Spontaneous peripheral dissections are rare, and in a substantial number of cases, the underlying aetiology remains unclear. Patients and methods: We report the case of a 63-year-old male patient with a recent asymptomatic SARS-CoV-2 infection who presented with sudden-onset intermittent abdominal pain. Imaging studies revealed a dissection of the superior mesenteric artery (SMA) and large-vessel vasculitis involving the SMA as well as the carotid, subclavian, axillary and femoropopliteal arteries. In the absence of other predisposing factors, we supposed an association with prior COVID-19 and performed a systematic review of the literature to search for similar cases with arterial dissection related to acute or recent SARS-CoV-2 infection. Results: We identified 25 cases, including ours: 13 males and 12 females, with a median age of 48 years. In 22/25 patients, arterial dissection occurred within 4 weeks after the diagnosis of COVID-19 and involved the cerebral (11/25; 44%), coronary (10/25; 40%), splanchnic (3/25; 12%) and renal (2/25; 8%) arteries. Conclusions: Although initially known for its respiratory manifestations, it has become evident that SARS-CoV-2 not only infects pneumocytes but also enters the vascular endothelium, leading to endothelial dysfunction and hypercoagulability and - as shown in our case - large-vessel vasculitis, which may predispose patients to intramural haemorrhage and arterial dissection.
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Affiliation(s)
- Leszek Kukulski
- Department of Vascular Surgery, University Hospital Regensburg, Germany.,Department of Cardiac, Vascular and Endovascular Surgery and Tranplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Gregor Scharf
- Department of Radiology, Interventional Radiology, University Hospital Regensburg, Germany
| | - Wilma Schierling
- Department of Vascular Surgery, University Hospital Regensburg, Germany
| | - Karin Pfister
- Department of Vascular Surgery, University Hospital Regensburg, Germany
| | - Birgit Linnemann
- Division of Angiology, East Bavarian Center of Vascular Medicine, University Hospital Regensburg, Germany
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Krzelj K, Anic D. Aortic Dissection and COVID-19 Pneumonia in a Pregnant Woman at 34 Weeks of Gestation. Tex Heart Inst J 2023; 50:490619. [PMID: 36735917 PMCID: PMC9969779 DOI: 10.14503/thij-22-7854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Between 0.1% and 0.3% of all aortic dissections occur during pregnancy. Arterial hypertension, connective tissue disorders, and congenital cardiovascular anomalies-including bicuspid aortic valves-are well-known risk factors. The causality between pregnancy and aortic dissection is unclear, but there have been some observations that COVID-19 illness may increase the risk. This report describes a pregnant woman at 34 weeks of gestation who had a bicuspid aortic valve and experienced an acute aortic dissection while ill with COVID-19 pneumonia. Computed tomography confirmed a type A aortic dissection and bilateral patchy pulmonary opacities. Cesarean delivery was performed, followed by replacement of the aortic valve with a mechanical aortic prosthesis and reconstruction of the ascending aorta and hemiarch. The intraoperative course was uneventful, and the patient was successfully weaned from mechanical ventilation after 51 hours. COVID-19 during pregnancy seems to increase the risk for aortic dissection, although there is no evidence base for an association. Because guidelines for diagnosis and treatment in such complex cases are lacking, care from a multidisciplinary team is crucial for successful outcomes.
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Affiliation(s)
- Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darko Anic
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
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8
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Song Y, Fan H, Tang X, Luo Y, Liu P, Chen Y. The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on ischemic stroke and the possible underlying mechanisms. Int J Neurosci 2023; 133:176-185. [PMID: 33653215 PMCID: PMC8006265 DOI: 10.1080/00207454.2021.1897588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 12/05/2020] [Accepted: 02/14/2021] [Indexed: 02/01/2023]
Abstract
Purpose: As of November 28, 2020, COVID-19 has been reported in 220 countries with 61,036,793 confirmed cases and 1,433,316 confirmed deaths; countries became vigilant around the world. In addition to SARS-CoV-2 causing pneumonia, many studies have reported ischemic stroke in patients with COVID-19. This article describes the effects and possible underlying mechanisms of SARS-CoV-2 on ischemic stroke.Materials and methods: A literature search was performed using PubMed, Web of Science, and other COVID-dedicated databases and the combination of the keywords 'SARS-CoV-2', 'COVID-19' and 'ischemic stroke' up to November 28, 2020.Results: SARS-CoV-2 invades the host through angiotensin converting enzyme 2 (ACE2). ACE2 is expressed not only in the lungs, but also in the brain and vascular endothelial cells. SARS-CoV-2 infection might cause direct vascular disease or enhance the immunogenic thrombosis environment through several mechanisms. SARS-CoV-2 infection can modulate the host immune response and can cause inflammation, coagulation disorders, renin angiotensin system disorders, hypoxia, and stress disorders, which may lead to the occurrence of ischemic stroke.Conclusions: Some patients with COVID-19 can develop ischemic stroke. Ischemic stroke has a high risk of causing disability and is associated with a high mortality rate. It is hoped that when medical staff treat patients with COVID-19, they would pay attention to the occurrence of ischemic stroke to improve the prognosis of patients with COVID-19.
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Affiliation(s)
- Yuxia Song
- Department of Neurology, Dalian Medical University, Dalian, Liaoning, China
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Hongyang Fan
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - XiaoJia Tang
- Department of Neurology, Dalian Medical University, Dalian, Liaoning, China
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yuhan Luo
- Department of Neurology, Dalian Medical University, Dalian, Liaoning, China
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Peipei Liu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Yingzhu Chen
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
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9
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Chang S, Schecht M, Jain R, Belani P. Acute Neurological Complications of Coronavirus Disease. Neuroimaging Clin N Am 2023; 33:57-68. [PMID: 36404047 PMCID: PMC9288970 DOI: 10.1016/j.nic.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The coronavirus disease (COVID-19) pandemic has impacted many lives globally. Neurologic manifestations have been observed among individuals at various stages and severity of the disease, the most common being stroke. Prompt identification of these neurologic diagnoses can affect patient management and prognosis. This article discusses the acute neuroradiological features typical of COVID-19, including cerebrovascular disease, intracerebral hemorrhage, leukoencephalopathy, and sensory neuropathies.
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Affiliation(s)
- Sanders Chang
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1176 5th Avenue MC Level, New York, NY 10029, USA
| | - Michael Schecht
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1176 5th Avenue MC Level, New York, NY 10029, USA
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, 1st Floor, New York, NY 10016, USA,Department of Neurosurgery, NYU Grossman School of Medicine, 660 1st Avenue, 1st Floor, New York, NY 10016, USA
| | - Puneet Belani
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1176 5th Avenue MC Level, New York, NY 10029, USA,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1176 5th Avenue MC Level, New York, NY 10029, USA,Corresponding author. 1176 5th Avenue MC Level, New York, NY 10029
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10
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Abraham B, Mathew SD, Sridharan K. A Systematic Review of Arterial Dissections in COVID-19 Patients. Curr Cardiol Rev 2023; 19:e280622206435. [PMID: 35762547 PMCID: PMC10201876 DOI: 10.2174/1573403x18666220628093303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION COVID-19 is often seen presenting with a myriad of signs and symptoms of multiorgan dysfunction including arterial dissection. METHODS Various theories have been proposed such as endothelial dysfunction triggered by hyperinflammatory response that results in rupture of atherosclerotic plaque and subsequent dissection. RESULTS However, the exact incidence is unknown and only case reports and case series have been published till date. CONCLUSION Here we carried out a systematic analysis of published case reports/series related to dissection of the aorta, coronary, cerebral, vertebral, cervical, renal, and splanchnic arteries.
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Affiliation(s)
- Betsy Abraham
- Department of Intensive Care, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | | | - Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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11
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Simonetto M, Wechsler PM, Merkler AE. Stroke Treatment in the Era of COVID-19: a Review. Curr Treat Options Neurol 2022; 24:155-171. [PMID: 35497091 PMCID: PMC9035774 DOI: 10.1007/s11940-022-00713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review To describe a comprehensive review of the epidemiology, pathophysiology, and treatment of stroke in the era of COVID-19. Recent Findings COVID-19 is associated with myriad neurological disorders, including cerebrovascular disease. While ischemic stroke is the most common, COVID-19 is associated with an increased risk of intracranial hemorrhage, arterial dissection, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis. In this review, we discuss the epidemiology, pathophysiology, and treatment of stroke due to COVID-19. In addition, we describe how COVID-19 has changed the landscape of stroke systems of care and the effect this has had on patients with cerebrovascular disease. Summary While COVID-19 is associated with a heightened risk of stroke, the pandemic has led to advances in stroke systems of care that may reduce the long-term burden of stroke.
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Affiliation(s)
- Marialaura Simonetto
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, Room F610, 525 East 68th Street, New York, NY 10065 USA
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY USA
| | - Paul M. Wechsler
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, Room F610, 525 East 68th Street, New York, NY 10065 USA
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY USA
| | - Alexander E. Merkler
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, Room F610, 525 East 68th Street, New York, NY 10065 USA
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY USA
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12
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Mooney N, White LM, Chandran A, Bonello M. Vertebral artery dissection managed by interventional radiology. BMJ Case Rep 2022; 15:e245914. [PMID: 35228219 PMCID: PMC8886384 DOI: 10.1136/bcr-2021-245914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/04/2022] Open
Abstract
A 21-year-old patient presented with sudden-onset headache, visual disturbance and left hand incoordination. She was diagnosed with a left vertebral artery dissection of the V3 segment resulting in multiple cerebellar and cerebral infarcts. There were no risk factors for dissection other than recent COVID-19 infection. She was treated initially with antiplatelets, followed by anticoagulation, but experienced recurrent ischaemia. Although guidance suggests endovascular repair may be beneficial for patients with cerebral artery dissection (CAD) who experience recurrent strokes on medical therapy, evidence is limited. After multidisciplinary team consideration of the individual patient anatomy and risks and benefits of different endovascular techniques, the patient was treated with endovascular coiling. At 10 months follow-up, she had no further strokes and improving neurological symptoms. The case highlighted COVID-19 as a potential trigger for CAD and the use of endovascular coiling in preventing catastrophic cerebral ischaemia in CAD refractive to medical therapy.
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Affiliation(s)
- Nicole Mooney
- Department of Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Laura M White
- Department of Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Arun Chandran
- Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael Bonello
- Department of Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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13
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Alloush TK, Alloush AT, Marzouk F, Abdulghani KO, Shokri HM. Post-COVID isolated subclavian artery dissection with multiple cerebral infarctions. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:114. [PMID: 36212672 PMCID: PMC9526528 DOI: 10.1186/s41983-022-00549-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is a pandemic disease which predominantly affects the respiratory system with high critical care mortality and morbidity, yet it also causes multiple organs dysfunction in affected patients. There is a strong evidence that it increases the susceptibility of cerebrovascular strokes in such patients. Besides this prothrombotic complication, arterial dissection can be one of its mechanisms increasing the risks of stroke. Case presentation Herein, we report a case of spontaneous isolated subclavian artery dissection in a COVID-19 patient. Sixty-one-year-old female presented with spontaneous isolated subclavian artery dissection without any traumatic events nor history of connective tissue disorders. She had left upper limb ischemia followed by cerebellar, thalamic and occipital infarctions. Whether this patient’s subclavian artery dissection was triggered by exaggerated inflammatory response or arteriopathy secondary to COVID-19 remains speculative. Conclusions Nonetheless, arterial dissection can be one of its complications, it is essential for treating physicians to be attentive for the diversity of COVID-19 clinical manifestations.
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Affiliation(s)
- Taha K. Alloush
- grid.7269.a0000 0004 0621 1570Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adel T. Alloush
- grid.7269.a0000 0004 0621 1570Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fayez Marzouk
- Departement of Vascular Surgery, The Good Shepherd, Italian and alHaya Hospitals, Cairo, Egypt
| | - Khaled O. Abdulghani
- grid.412093.d0000 0000 9853 2750Department of Neurology and Psychiatry, Helwan University School of Medicine, Cairo, Egypt
| | - Hossam M. Shokri
- grid.7269.a0000 0004 0621 1570Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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14
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Spine artery dissection as another puzzle of Covid-19 (Clinical case). Fam Med 2021. [DOI: 10.30841/2307-5112.4.2021.249420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Keith P, Saint-Jour M, Pusey F, Hodges J, Jalali F, Scott LK. Unprovoked serotonin syndrome-like presentation of SARS-CoV-2 infection: A small case series. SAGE Open Med Case Rep 2021; 9:2050313X211032089. [PMID: 34290872 PMCID: PMC8274092 DOI: 10.1177/2050313x211032089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/23/2021] [Indexed: 11/17/2022] Open
Abstract
Clinicians and researchers have reported an array of neurological abnormalities in coronavirus disease 2019 (COVID-19), and while serotonin excess has been observed we are unaware of reports of central nervous system serotonin toxicity in COVID-19. We present two cases that resemble serotonin syndrome in COVID-19, but without identifiable inciting medications. A 54-year-old with multiple sclerosis and diabetes mellitus presented with altered mental status. His altered sensorium was attributed to diabetic ketoacidosis, but his condition quickly deteriorated with fever to 105 degrees Fahrenheit, rigidity in all extremities, inducible clonus, and hyperreflexia. He was intubated and was treated for possible meningitis and seizure. Neurologic workup was negative for acute pathology. Despite acetaminophen, his core temperature remained elevated to 105 degrees Fahrenheit. He was treated with external cooling and cyproheptadine and within 48 h, his fever, rigidity, hyperreflexia, and clonus resolved. He was extubated and discharged home on day 14. A 72-year-old with hyperlipidemia was admitted with tremors, 4 days after testing positive for COVID-19. His symptoms rapidly worsened, and he was transferred to the Intensive Care Unit on day 3 in extremis, febrile to 104.4 degrees Fahrenheit, heart rate of 180 beats per minute, and apparent whole body myoclonus. He was intubated and developed fever refractory to acetaminophen requiring external cooling. Extensive neurologic workup was negative. He received cyproheptadine and slowly improved. He was extubated and discharged to rehab on day 11. These cases represent a unique presentation in COVID-19 that must be considered and requires a high index of suspicion.
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Affiliation(s)
- Philip Keith
- Critical Care Medicine, Lexington Medical Center, West Columbia, SC, USA
| | - Marc Saint-Jour
- Internal Medicine, Lexington Medical Center, West Columbia, SC, USA
| | - Frank Pusey
- Neurology, Lexington Medical Center, West Columbia, SC, USA
| | - Jeremy Hodges
- Critical Care Clinical Pharmacy, Novant Health Forsyth Medical Center, Winston-Salem, NC, USA
| | - Farid Jalali
- Division of Gastroenterology, Saddleback Medical Group, Laguna Hills, CA, USA
| | - L Keith Scott
- Division of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA.,Participating Study Center, Lexington Medical Center, West Columbia, SC, USA
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16
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Unilateral common carotid artery dissection in a patient with recent COVID-19: An association or a coincidence? J Clin Neurosci 2021; 87:26-28. [PMID: 33863528 PMCID: PMC7919518 DOI: 10.1016/j.jocn.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/23/2022]
Abstract
The "Corona Virus Disease 2019 (COVID-19)", caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), progressed rapidly since its first outbreak, and quickly developed into a pandemic. Although COVID-19 mostly presents with respiratory symptoms, researchers have started reporting neurologic manifestations such as cerebrovascular diseases in patients, with COVID-19 as the pandemic has progressed. Herein, we report a case of 38-year-old female patient identified with a left common carotid artery dissection, with COVID-19. Clinicians must keep in mind that COVID-19 can cause vascular complications such as carotid artery dissections in the ensuing period, even after the acute phase, although there is currently a lack of sufficient evidence to identify any causal association between COVID-19 and arterial dissections.
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17
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Spontaneous Renal Artery Dissection in COVID-19 Pneumonia: Potential Danger of Cytokine Storm. Case Rep Crit Care 2021; 2021:6696443. [PMID: 33927903 PMCID: PMC8051521 DOI: 10.1155/2021/6696443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/20/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has rapidly spread across the globe since its first detection in March 2020. Its widespread manifestations and vascular complications are increasingly being reported even in young and middle-aged patients. Hyperinflammation is a continuum of host's exaggerated inflammatory response representing cytokine dysregulation/storm which produces coagulopathy and vascular endothelial dysfunction, apart from a prothrombotic state. Cytokine storm or direct viral invasion of the vascular endothelial cells through surface angiotensin-converting enzyme 2 receptors may result in endothelial dysfunction which can potentially result in dissection. Only a few case reports have been published in the literature describing vascular dissection without any inciting factors in COVID-19 patients. Herein, we present the first case report of bilateral renal artery dissection in a 41-year-old male patient who recently recovered from COVID-19 and was managed successfully in stages after many medical hurdles.
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18
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Uginet M, Breville G, Hofmeister J, Machi P, Lalive PH, Rosi A, Fitsiori A, Vargas MI, Assal F, Allali G, Lovblad KO. Cerebrovascular Complications and Vessel Wall Imaging in COVID-19 Encephalopathy-A Pilot Study. Clin Neuroradiol 2021; 32:287-293. [PMID: 33770199 PMCID: PMC7995679 DOI: 10.1007/s00062-021-01008-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/26/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with several complications of the central nervous system (CNS), including acute encephalopathy. METHODS In this pilot study, we report a series of 39 patients (66.5 ± 9.2 years; 10.3% female) with acute encephalopathy, who underwent a standard brain magnetic resonance imaging (MRI) at 1.5 T during the acute symptomatic phase. In addition to diffusion-weighted imaging, MR angiography and susceptibility-weighted images, high-resolution vascular black blood sequences (in 34 cases) were used to investigate the vasculature of the brain. RESULTS In 29 out of 34 patients with COVID-19 encephalopathy (85%) with high-resolution vessel wall imaging, we found a circular enhancement and thickening of the basilar and vertebral arteries, without any correlation with ischemia or microbleeds (reported in 21% and 59%, respectively). CONCLUSION We report a high prevalence of vascular changes suggestive of endotheliitis as reported in other organs. This could suggest an inflammatory mechanism underlying this encephalopathy.
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Affiliation(s)
- Marjolaine Uginet
- Division of Neurology, Clinical Neurosciences Department, Geneva University Hospitals, Geneva, Switzerland
| | - Gautier Breville
- Division of Neurology, Clinical Neurosciences Department, Geneva University Hospitals, Geneva, Switzerland
| | - Jérémy Hofmeister
- Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, 1211, Geneva, Switzerland
| | - Paolo Machi
- Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, 1211, Geneva, Switzerland
| | - Patrice H Lalive
- Division of Neurology, Clinical Neurosciences Department, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Rosi
- Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, 1211, Geneva, Switzerland
| | - Aikaterini Fitsiori
- Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, 1211, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, 1211, Geneva, Switzerland
| | - Frederic Assal
- Division of Neurology, Clinical Neurosciences Department, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Allali
- Division of Neurology, Clinical Neurosciences Department, Geneva University Hospitals, Geneva, Switzerland.,Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Karl-Olof Lovblad
- Division of Neuroradiology, Diagnostic Department, Geneva University Hospitals, 1211, Geneva, Switzerland.
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19
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Frisullo G, Scala I, Bellavia S, Broccolini A, Brunetti V, Morosetti R, Della Marca G, Calabresi P. COVID-19 and stroke: from the cases to the causes. Rev Neurosci 2021; 32:659-669. [PMID: 33583167 DOI: 10.1515/revneuro-2020-0136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
During COVID-19 pandemic, a wide variety of stroke typologies have been described in patients affected by SARS-CoV-2. Investigating the case reports of acute stroke in COVID-19 patients, published since the beginning of the pandemic, we tried to trace the pathogenic mechanisms of stroke during SARS-CoV-2 infection. We conducted a systematic review analyzing demographic data, cerebrovascular risk factors, NIHSS score, vascular territory involvement and laboratory findings of 168 patients described in 89 studies, from a pool of 1243 records. Based on our results, we have identified different stroke profiles: (1) cerebral large vessel disease (CLVD) profile with a low disability, simultaneous onset of COVID-19 and stroke symptoms, good outcome and low serum levels of D-dimer and CRP; (2) intracranial bleeding (IB) profile with high disability, poor outcome and low levels of serum markers of inflammation and coagulopathy; (3) CLVD profile with a short time-lapse between COVID-19 symptoms and stroke onset, high neurological disability and very high systemic inflammatory markers; (4) multiple thrombo-embolic disease (MTED) profile with older patients, many comorbidities, disabling stroke, poor outcome, evident alteration of coagulation tests and high serum levels of both D-dimer and CRP. We therefore summarized these different profiles in a spectrum similar to that of visible light, where the violet-blue band included IB and CSVD with low inflammation and prothrombotic activity, the green-yellow band included CLVD with high inflammation and moderate prothrombotic activity and the orange-red band for MTED with moderate-high levels of inflammation and very high prothrombotic activity.
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Affiliation(s)
- Giovanni Frisullo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Irene Scala
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Simone Bellavia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Aldobrando Broccolini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Valerio Brunetti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Roberta Morosetti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Giacomo Della Marca
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
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20
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Al-Mufti F, Becker C, Kamal H, Alshammari H, Dodson V, Nuoman R, Dakay K, Cooper J, Gulko E, Kaur G, Sahni R, Scurlock C, Mayer SA, Gandhi CD. Acute Cerebrovascular Disorders and Vasculopathies Associated with Significant Mortality in SARS-CoV-2 Patients Admitted to The Intensive Care Unit in The New York Epicenter. J Stroke Cerebrovasc Dis 2021; 30:105429. [PMID: 33276301 PMCID: PMC7605750 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105429] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/21/2020] [Accepted: 10/24/2020] [Indexed: 12/21/2022] Open
Abstract
The current Coronavirus pandemic due to the novel SARS-Cov-2 virus has proven to have systemic and multi-organ involvement with high acuity neurological conditions including acute ischemic strokes. We present a case series of consecutive COVID-19 patients with cerebrovascular disease treated at our institution including 3 cases of cerebral artery dissection including subarachnoid hemorrhage. Knowledge of the varied presentations including dissections will help treating clinicians at the bedside monitor and manage these complications preemptively.
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Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY USA
| | - Christian Becker
- Department of Internal Medicine -Division of Pulmonary and Critical Care, Westchester Medical Center at New York Medical College, Valhalla, NY USA
| | - Haris Kamal
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY USA.
| | - Hussein Alshammari
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY USA
| | - Vincent Dodson
- Department of Surgery, Rutgers University New Jersey Medical School, Newark, NJ USA
| | - Rolla Nuoman
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY USA
| | - Katarina Dakay
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY USA
| | - Jared Cooper
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY USA
| | - Edwin Gulko
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Internal Medicine -Division of Pulmonary and Critical Care, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Surgery, Rutgers University New Jersey Medical School, Newark, NJ USA; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY 10595 USA
| | - Gurmeen Kaur
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Internal Medicine -Division of Pulmonary and Critical Care, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Surgery, Rutgers University New Jersey Medical School, Newark, NJ USA; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY 10595 USA
| | - Ramandeep Sahni
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY USA
| | - Corey Scurlock
- Department of Internal Medicine -Division of Pulmonary and Critical Care, Westchester Medical Center at New York Medical College, Valhalla, NY USA
| | - Stephan A Mayer
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY USA
| | - Chirag D Gandhi
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY USA; Department of Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY USA
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21
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Ladopoulos T, Zand R, Shahjouei S, Chang JJ, Motte J, Charles James J, Katsanos AH, Kerro A, Farahmand G, Vaghefi Far A, Rahimian N, Ebrahimzadeh SA, Abedi V, Papathanasiou M, Labedi A, Schneider R, Lukas C, Tsiodras S, Tsivgoulis G, Krogias C. COVID-19: Neuroimaging Features of a Pandemic. J Neuroimaging 2021; 31:228-243. [PMID: 33421032 PMCID: PMC8014046 DOI: 10.1111/jon.12819] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE The ongoing Coronavirus Disease 2019 (COVID-19) pandemic is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is occasionally associated with manifold diseases of the central nervous system (CNS). We sought to present the neuroimaging features of such CNS involvement. In addition, we sought to identify typical neuroimaging patterns that could indicate possible COVID-19-associated neurological manifestations. METHODS In this systematic literature review, typical neuroimaging features of cerebrovascular diseases and inflammatory processes associated with COVID-19 were analyzed. Reports presenting individual patient data were included in further quantitative analysis with descriptive statistics. RESULTS We identified 115 studies reporting a total of 954 COVID-19 patients with associated neurological manifestations and neuroimaging alterations. A total of 95 (82.6%) of the identified studies were single case reports or case series, whereas 660 (69.2%) of the reported cases included individual information and were thus included in descriptive statistical analysis. Ischemia with neuroimaging patterns of large vessel occlusion event was revealed in 59.9% of ischemic stroke patients, whereas 69.2% of patients with intracerebral hemorrhage exhibited bleeding in a location that was not associated with hypertension. Callosal and/or juxtacortical location was identified in 58.7% of cerebral microbleed positive images. Features of hemorrhagic necrotizing encephalitis were detected in 28.8% of patients with meningo-/encephalitis. CONCLUSIONS Manifold CNS involvement is increasingly reported in COVID-19 patients. Typical and atypical neuroimaging features have been observed in some disease entities, so that familiarity with these imaging patterns appears reasonable and may assist clinicians in the differential diagnosis of COVID-19 CNS manifestations.
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Affiliation(s)
- Theodoros Ladopoulos
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ramin Zand
- Department of Neurology, Geisinger Medical Center, Danville, PA
| | - Shima Shahjouei
- Department of Neurology, Geisinger Medical Center, Danville, PA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC.,Department of Neurology, Georgetown University Medical Center, Washington, DC
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | | | - Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Ali Kerro
- SCL Health Neuroscience Department, Billings, MT
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alaleh Vaghefi Far
- Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Vida Abedi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA
| | - Matilda Papathanasiou
- Second Department of Radiology, University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Adnan Labedi
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
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22
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Asan L, Deuschl C, Forsting M, Kleinschnitz C, Köhrmann M. Oropharyngeal swab for SARS-CoV-2 test causing atypical internal carotid artery dissection and stroke in a patient after mild COVID-19. Ther Adv Neurol Disord 2021; 14:17562864211033521. [PMID: 35173807 PMCID: PMC8842151 DOI: 10.1177/17562864211033521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022] Open
Abstract
We report a patient who had recovered from pneumonia caused by severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) presenting with acute cerebral ischemia due to
atypical dissection of the left internal carotid artery immediately after an oropharyngeal
swab (OPS) for SARS-CoV-2 RT-PCR testing. The symptoms consisting of right-side
hemiparesis and aphasia improved after systemic thrombolysis and the patient recovered
completely in the further course. We demonstrate findings from imaging (computed
tomography, magnetic resonance imaging, neurovascular ultrasound) among other
investigations and discuss coronavirus disease 2019 (COVID-19)-related vessel wall
vulnerability as well as tissue injury posed by the swab procedure as underlying causes of
the dissection. Individuals performing OPSs during the corona pandemic should be aware of
this so far undescribed complication.
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Affiliation(s)
- Livia Asan
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
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23
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Roncati L, Manenti A, Manco G, Farinetti A, Mattioli A. The COVID-19 Arterial Thromboembolic Complications: From Inflammation to Immunothrombosis Through Antiphospholipid Autoantibodies. Ann Vasc Surg 2020; 72:216-217. [PMID: 33387619 PMCID: PMC7837102 DOI: 10.1016/j.avsg.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Luca Roncati
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Manenti
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy.
| | - Gianrocco Manco
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Farinetti
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
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24
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Vogrig A, Bagatto D, Gigli GL, Cobelli M, D'Agostini S, Bnà C, Morassi M. Causality in COVID-19-associated stroke: a uniform case definition for use in clinical research. J Neurol 2020; 268:758-761. [PMID: 32740765 PMCID: PMC7395574 DOI: 10.1007/s00415-020-10103-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Alberto Vogrig
- Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, Udine, 33010, Italy.
| | - Daniele Bagatto
- Unit of Neuroradiology, Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, Udine, 33010, Italy
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
- Department of Mathematics, Informatics and Physics (DMIF), University of Udine, Udine, Italy
| | - Milena Cobelli
- Unit of Neuroradiology, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Serena D'Agostini
- Unit of Neuroradiology, Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Claudio Bnà
- Unit of Radiology, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Mauro Morassi
- Unit of Neuroradiology, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
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