Stroke - next wave of complications from covid-19
Keywords:
stroke, covid-19, NCCTAbstract
Risk factors and hospital events associated with the occurrence of stroke in covid-19 are not yet well known. We analyzed four patients aged 51, 39, 81, and 42 years (represented as cases 1, 2, 3, and 4, respectively), who were admitted with SARS-CoV-2 RT-PCR or antigen positive reports. Inflammatory markers like C-reactive protein (CRP), D-dimer, ferritin, leucocytes, platelets, lactate dehydrogenase (LDH), and liver biomarkers were assessed. All the patients had abnormal NCCT head imaging with hypodense areas involving the left occipital, thalamus, and corona radiata causing ischemic infract or effacement of adjacent sulcal spaces infract. Case 1 and 3 patients survived the treatment and were discharged. While Case 2 and 4 patients underwent sudden cardiac arrest despite all resuscitation efforts. These patients possessed altered sensorium, hemiparesis, hemiplegia, and seizures, along with common respiratory symptoms. While blood biomarkers and NCCT imaging have shown the severity of patients, these tests must be carried out worldwide to decrease the severity of therapy at its early stage. Early biomarker detection might assist physicians to increase prognosis during early infection periods. Thus, more research would improve the results worldwide.
References
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020; 395:1054-62.
WHO pneumonia of unknown cause – China. Available: https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/
Salamanna F, Maglio M, Landini MP, Fini M. Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2. Front Med, 2020; 7:594495.
Qin C, Zhou L, Hu Z, et al. Dysregulation of Immune Response in Patients with Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis, 2020; 71(15):762–8.
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost, 2020; 18(4):844–7.
Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med, 2020; 382(17):e38–e38.
Lippi G, Sanchis-Gomar F, Favaloro EJ, Lavie CJ, Henry BM. Coronavirus Disease 2019-Associated Coagulopathy. Mayo Clin Proc, 2021; 96(1):203–17.
Hadid T, Kafri Z, Al-Katib A. Coagulation and anticoagulation in COVID-19. Blood Rev, 2021; 47:100761.
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020; 395(10223):507–13.
Desai I, Manchanda R, Kumar N, Tiwari A, Kumar M. Neurological manifestations of coronavirus disease 2019: exploring past to understand present. Neurol Sci, 2021; 42(3):773–85.
Boehme AK, Ranawat P, Luna J, Kamel H, Elkind MS V. Risk of Acute Stroke After Hospitalization for Sepsis: A Case-Crossover Study. Stroke, 2017; 48(3):574–80.
González-Pinto T, Luna-Rodríguez A, Moreno-Estébanez A, Agirre-Beitia G, Rodríguez-Antigüedad A, Ruiz-Lopez M. Emergency room neurology in times of COVID-19: malignant ischaemic stroke and SARS-CoV-2 infection. Eur J Neurol, 2020; 27(9):e35–6.
Puelles VG, Lütgehetmann M, Lindenmeyer MT, et al. Multiorgan and Renal Tropism of SARS-CoV-2. N Engl J Med, 2020; 383(6):590–2.
Zubair AS, McAlpine LS, Gardin T, Farhadian S, Kuruvilla DE, Spudich S. Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review. JAMA Neurol, 2020; 77(8):1018–27.
Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis, 2020; 94:55–8.
Reichard RR, Kashani KB, Boire NA, et al. Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology. Acta Neuropathol, 2020; 140:1-6.
Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol, 2020; 19(5):383–4.
Toscano G, Palmerini F, Ravaglia S, et al. Guillain-Barré Syndrome Associated with SARS-CoV-2. N Engl J Med, 2020; 382(26):2574–6.
Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy: Imaging Features. Radiology, 2020; 296(2):E119–20.
Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet, 2020; 395(10234):1417–8.
Pons-Escoda A, Naval-Baudín P, Majós C, et al. Neurologic Involvement in COVID-19: Cause or Coincidence? A Neuroimaging Perspective. AJNR Am J Neuroradiol, 2020; 41(8):1365–1369.
Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID‐19. J Thromb Haemost, 2020; 18(7):1559–61.
Beyrouti R, Adams ME, Benjamin L, et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry, 2020; 91(8):889–91.
Chougar L, Shor N, Mathon B, Degos V, Weiss N. Atypical Deep Cerebral Vein Thrombosis with Hemorrhagic Venous Infarction in a COVID-19-Positive Patient. Am J Neuroradiol, 2020; 41(8):1377-1379.
Franceschi AM, Ahmed O, Giliberto L, Castillo M. Hemorrhagic Posterior Reversible Encephalopathy Syndrome as a Manifestation of COVID-19 Infection. AJNR Am J Neuroradiol, 2020; 41(7):1173–1176.
Ellul MA, Benjamin L, Singh B, et al. Neurological associations of COVID-19. Lancet Neurol, 2020; 19(9):767–83.
Venkata C, Kashyap R, Farmer JC, Afessa B. Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcome. J intensive care, 2013; 1(1):9.
Guzik TJ, Mohiddin SA, Dimarco A, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res, 2020; 116(10):1666–1687.
Jin Y, Yang H, Ji W, et al. Virology, Epidemiology, Pathogenesis, and Control of COVID-19. Viruses, 2020; 12(4):372.
Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19). JAMA, 2020; 323(18):1824–1836.
Zanin L, Saraceno G, Panciani PP, et al. SARS-CoV-2 can induce brain and spine demyelinating lesions. Acta Neurochir, 2020; 162(7):1491–1494
