COVID-19 and Stroke

Year 2021, , 124 - 128, 01.05.2021

Feyza Sönmez Topcu , Şirin Yurtlu Temel Yıldıray Tutpınar

https://doi.org/10.19127/bshealthscience.844062

Abstract

Most patients with COVID-19 present with constitutional and respiratory symptoms and some with atypical gastrointestinal, cardiovascular, or neurological manifestations. Recent studies suggest that there are neurologic manifestations of COVID-19, including acute cerebrovascular disease (CVD). The aim of this study is to find out any evidence of COVID-19 related stroke. Radiologic studies of the patients admitted to the emergency department (ED) of our center from March 11 Th to June 10 Th 2020, with acute stroke symptoms and of whom the acute cerebrovascular disease is confirmed by Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) are searched retrospectively. CT Angiography (CTA) and MR Angiography (MRA) studies obtained for stroke management, searched for acute thromboembolism. We noticed some radiologic evidence of acute cerebrovascular disease in 56 patients of 528 patients admitted with immediate neurological symptoms. 11 (19.64 %) of these patients who were not diagnosed before, proved to be simultaneous COVID-19 infection with laboratory tests and/or thorax CT. It was noteworthy that these 11 patients presented with an acute cerebrovascular event supported by neurological and radiological findings instead of the well-known constitutional or respiratory symptoms of COVID 19 infection. 45 (80.35 %) patients were negative for COVID-19 infection. CT /or MR Angiography demonstrated carotid or intracranial major arterial thromboembolism in 5 (11.1 %) of the non-COVID-19 patients and 5 (45.4 %) of the simultaneous COVID-19 disease diagnosed ones. COVID19 positive 5 patients presented with acute internal carotid artery (ICA) or major ICA branch thrombosis at the first stage of COVID-19 infection, rather than a complication of the serious lung disease or a component of multiorgan disfunction related COVID-19. Acute cerebrovascular disease symptoms bringing patients to the ED instead of the respiratory symptoms, aroused high suspicion of the direct neuropathy and early coagulopathy effect of the virus. COVID- 19 disease, itself thought to be a great risk factor for stroke alone. Even in initial cases and in cases where COVID-19 infection do not show a severe and fatal course, stimulation in the coagulation cascade in the early stages, increased the risk of acute stroke.

Keywords

COVID- 19, SARS Cov-2, Acute cerebrovascular disease, Infection related stroke

Supporting Institution

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Project Number

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References

• Akhmerov A, Marbán E. 2020. COVID-19 and the heart. Circ Res, 126(10): 1443-1455.
• Avula A, Nalleballe K, Narula N, Sapozhnikov S, Dandu V, Toom S, Glaser A, Elsayegh D. 2020. COVID-19 presenting as stroke. Brain Behav Immun, 87: 115-119. DOI: 10.1016/j.bbi.2020.04.077.
• Cucinotta D, Vanelli M. 2020. WHO declares COVID-19 a pandemic. Acta Biomed, 91(1): 157-160. DOI: 10.23750/abm.v91i1.9397.
• Ge XY, Li JL, Yang XL. 2013. Isolation and characterization of a bat SARS-like coronavirus that uses the ACE2 receptor. Nature, 503: 535-538. DOI: 10.1038/nature12711.
• Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, Boulay C, Fafi-Kremer S, Ohana M, Anheim M, Meziani F. 2020. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med, 382(23): 2268-2270. DOI: 10.1056/NEJMc2008597.
• Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G,
• Jiang R, Gao Z, Jin Q, Wang J, Cao B. 2020. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 395(10223): 497-506.
• Kansagra AP, Goyal MS, Hamilton S, Albers GW. 2020. Collateral effect of Covid-19 on stroke evaluation in the United States. N Engl J Med, 383(4): 400-401. DOI: 10.1056/NEJMc2014816.
• Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, Wang D, Mao L, Jin H, Hu B. 2020. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol, 5(3): 279-284. DOI: 10.1136/svn-2020-000431.
• Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B. 2020. Neurologic manifestations of hospitalized patients with Coronavirus disease 2019 in Wuhan, China. JAMA Neurol, 77(6): 683-690. DOI: 10.1001/jamaneurol.2020.1127.
• Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. 2020. HLH across speciality collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet, 395(10229): 1033-1034. DOI: 10.1016/S0140-6736(20)30628-0.
• Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, Ueno M, Sakata H, Kondo K, Myose N, Nakao A, Takeda M, Haro H, Inoue O, Suzuki-Inoue K, Kubokawa K, Ogihara S, Sasaki T, Kinouchi H, Kojin H, Ito M, Onishi H, Shimizu T, Sasaki Y, Enomoto N, Ishihara H, Furuya S, Yamamoto T, Shimada S. 2020. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis, 94: 55-58. DOI: 10.1016/j.ijid.2020.03.062.
• Phelan AL, Katz R, Gostin LO. 2020. The novel Coronavirus originating in Wuhan, China: Challenges for global health governance. JAMA, 323(8): 709-710. DOI: 10.1001/jama.2020.1097. PMID: 31999307.
• Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. 2020. COVID-19-associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology, Epub ahead of print 31 March 2020. DOI: 10.1148/radiol.2020201187.
• Steardo L, Steardo L Jr, Zorec R, Verkhratsky A. 2020. Neuroinfection may contribute to pathophysiology and clinical manifestations of COVID-19. Acta Physiol (Oxf), 229(3): e13473. DOI: 10.1111/apha.13473.
• Umapathi T, Kor AC, Venketasubramanian N. 2004. Large artery ischaemic stroke in severe acute respiratory syndrome (SARS). J Neurol, 251: 1227-1231. DOI: 10.1007/s00415-004-0519-8.
• Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, Liu C, Yang C. 2020. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun, 87: 18-22. DOI: 10.1016/j.bbi.2020.03.031.
• Xia H, Lazartigues E. 2008. Angiotensin-converting enzyme 2 in the brain: properties and future directions. J Neurochem, 107(6): 1482-1494. DOI: 10.1111/j.1471-4159.2008.
• Zhou P, Yang XL, Wang XG. 2020. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature, 579: 270-273. DOI: 10.1038/s41586-020-2012-7.