Stroke in patients with SARS-CoV-2 infection: case series.
Morassi M; Unit of Neuroradiology, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy. .
Bagatto D; Unit of Neuroradiology, Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy.
Cobelli M; Unit of Neuroradiology, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy.
D'Agostini S; Unit of Neuroradiology, Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy.
Gigli GL; Department of Medicine (DAME), University of Udine Medical School, Udine, Italy.; Department of Mathematics, Informatics and Physics (DMIF), University of Udine, Udine, Italy.; Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy.
Bnà C; Unit of Radiology, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
Vogrig A; Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy.
Journal of neurology [J Neurol] 2020 Aug; Vol. 267 (8), pp. 2185-2192. Date of Electronic Publication: 2020 May 20.
Typ publikacji :
Case Reports; Journal Article; Observational Study
Imprint Name(s) :
Original Publication: Berlin ; New York, Springer-Verlag
MeSH Terms :
Coronavirus Infections/*diagnostic imaging
Pneumonia, Viral/*diagnostic imaging
Aged ; Aged, 80 and over ; COVID-19 ; Coronavirus Infections/therapy ; Fatal Outcome ; Female ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/therapy ; Retrospective Studies ; SARS-CoV-2 ; Stroke/therapy
COVID-19 Map (2020) In: Johns Hopkins coronavirus resource center. https://coronavirus.jhu.edu/map.html . Accessed 6 Apr 2020.
Chen N, Zhou M, Dong X et al (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395:507–513. https://doi.org/10.1016/S0140-6736(20)30211-7. (PMID: 10.1016/S0140-6736(20)30211-771350767135076)
Guan W-J, Ni Z-Y, Hu Y et al (2020) Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. https://doi.org/10.1056/NEJMoa2002032. (PMID: 10.1056/NEJMoa2002032322202067121484)
Wang D, Hu B, Hu C et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. https://doi.org/10.1001/jama.2020.1585. (PMID: 10.1001/jama.2020.158572594657259465)
Umapathi T, Kor AC, Venketasubramanian N et al (2004) Large artery ischaemic stroke in severe acute respiratory syndrome (SARS). J Neurol 251:1227–1231. https://doi.org/10.1007/s00415-004-0519-8. (PMID: 10.1007/s00415-004-0519-8155031027088071)
Khosravani H, Rajendram P, Notario L et al (2020) Protected code stroke: hyperacute stroke management during the coronavirus disease 2019 (COVID-19) pandemic. Stroke. https://doi.org/10.1161/STROKEAHA.120.029838. (PMID: 10.1161/STROKEAHA.120.029838322339807309645)
Mortelliti MP, Manning HL (2002) Acute respiratory distress syndrome. Am Fam Physician 65:1823–1830. (PMID: 12018805)
Arabi YM, Harthi A, Hussein J et al (2015) Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV). Infection 43:495–501. https://doi.org/10.1007/s15010-015-0720-y. (PMID: 10.1007/s15010-015-0720-y45210864521086)
Li Y, Wang M, Zhou Y et al (2020) Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Social Science Research Network, Rochester.
Emsley HCA, Hopkins SJ (2008) Acute ischaemic stroke and infection: recent and emerging concepts. Lancet Neurol 7:341–353. https://doi.org/10.1016/S1474-4422(08)70061-9. (PMID: 10.1016/S1474-4422(08)70061-918339349)
Lavallée P, Perchaud V, Gautier-Bertrand M et al (2002) Association between influenza vaccination and reduced risk of brain infarction. Stroke 33:513–518. https://doi.org/10.1161/hs0202.102328. (PMID: 10.1161/hs0202.10232811823662)
Gilden D, Cohrs RJ, Mahalingam R, Nagel MA (2009) Varicella zoster virus vasculopathies: diverse clinical manifestations, laboratory features, pathogenesis, and treatment. Lancet Neurol 8:731–740. https://doi.org/10.1016/S1474-4422(09)70134-6. (PMID: 10.1016/S1474-4422(09)70134-6196080992814602)
Gilden DH, Kleinschmidt-DeMasters BK, Wellish M et al (1996) Varicella zoster virus, a cause of waxing and waning vasculitis: the New England Journal of Medicine case 5–1995 revisited. Neurology 47:1441–1446. https://doi.org/10.1212/wnl.47.6.1441. (PMID: 10.1212/wnl.47.6.14418960724)
Chetty R, Batitang S, Nair R (2000) Large artery vasculopathy in HIV-positive patients: another vasculitic enigma. Hum Pathol 31:374–379. https://doi.org/10.1016/s0046-8177(00)80253-1. (PMID: 10.1016/s0046-8177(00)80253-110746682)
Ding Y, Wang H, Shen H et al (2003) The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. J Pathol 200:282–289. https://doi.org/10.1002/path.1440. (PMID: 10.1002/path.144071680177168017)
Esper F, Shapiro ED, Weibel C et al (2005) Association between a novel human coronavirus and Kawasaki disease. J Infect Dis 191:499–502. https://doi.org/10.1086/428291. (PMID: 10.1086/428291156557717199489)
Wong RSM, Wu A, To KF et al (2003) Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ 326:1358–1362. https://doi.org/10.1136/bmj.326.7403.1358. (PMID: 10.1136/bmj.326.7403.135812816821162124)
Chong PY, Chui P, Ling AE et al (2004) Analysis of deaths during the severe acute respiratory syndrome (SARS) epidemic in Singapore: challenges in determining a SARS diagnosis. Arch Pathol Lab Med 128:195–204. https://doi.org/10.1043/1543-2165(2004)128%3c195:AODDTS%3e2.0.CO;2. (PMID: 10.1043/1543-2165(2004)128%3c195:AODDTS%3e2.0.CO;2)
COVID-19 (2020) Complicated by acute pulmonary embolism|radiology: cardiothoracic imaging. https://pubs.rsna.org/doi/10.1148/ryct.2020200067 . Accessed 8 Apr 2020.
Erez A, Shental O, Tchebiner JZ et al (2014) Diagnostic and prognostic value of very high serum lactate dehydrogenase in admitted medical patients. Isr Med Assoc J 16:439–443. (PMID: 25167691)
Moriguchi T, Harii N, Goto J et al (2020) A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. https://doi.org/10.1016/j.ijid.2020.03.062. (PMID: 10.1016/j.ijid.2020.03.062322517917195378)
Contributed Indexing :
Keywords: Brain hemorrhage; COVID-19; Cerebrovascular disease; Coronavirus; Encephalitis; Neurological complications
Entry Date(s) :
Date Created: 20200522 Date Completed: 20200722 Latest Revision: 20210216
Update Code :
PubMed Central ID :
Background: Italy is one of the most affected countries by the coronavirus disease 2019 (COVID-19). The responsible pathogen is named severe acute respiratory syndrome coronavirus (SARS-CoV-2). The clinical spectrum ranges from asymptomatic infection to severe pneumonia, leading to intensive care unit admission. Evidence of cerebrovascular complications associated with SARS-CoV-2 is limited. We herein report six patients who developed acute stroke during COVID-19 infection.
Methods: A retrospective case series of patients diagnosed with COVID-19 using reverse-transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs, who developed clinical and neuroimaging evidence of acute stroke during SARS-CoV-2 infection.
Results: Six patients were identified (5 men); median age was 69 years (range 57-82). Stroke subtypes were ischemic (4, 67%) and hemorrhagic (2, 33%). All patients but one had pre-existing vascular risk factors. One patient developed encephalopathy prior to stroke, characterized by focal seizures and behavioral abnormalities. COVID-19-related pneumonia was severe (i.e., requiring critical care support) in 5/6 cases (83%). Liver enzyme alteration and lactate dehydrogenase (LDH) elevation were registered in all cases. Four patients (67%) manifested acute kidney failure prior to stroke. Four patients (67%) had abnormal coagulation tests. The outcome was poor in the majority of the patients: five died (83%) and the remaining one (17%) remained severely neurologically affected (mRS: 4).
Conclusions: Both ischemic and hemorrhagic stroke can complicate the course of COVI-19 infection. In our series, stroke developed mostly in patients with severe pneumonia and multiorgan failure, liver enzymes and LDH were markedly increased in all cases, and the outcome was poor.
Comment in: J Neurol. 2021 Feb;268(2):424-430. (PMID: 32712866)