Year 2021, Volume 3 , Issue 1, Pages 31 - 34 2021-03-01

Imaging Findings of Ischemic Stroke Associated with COVID-19
COVID-19 ile İlişkili İskemik İnmenin Görüntüleme Bulguları

Nurdan GOCGUN [1] , Türkan İKİZCELİ [2]


Objective: We aimed to present the relationship between ischemic stroke and COVID-19, stroke types, and imaging findings in COVID-19 with stroke.

Material Method: From March to November 2020, COVID-19 diagnosed in patients with stroke (n=10) was included in the study retrospectively. To eliminate intracranial hemorrhage, a non-contrast computed tomography (CT) was performed for all patients. Then, magnetic resonance imaging (MRI) and Diffusion-Weighted MRI (DWI) (n=10) were obtained. Magnetic resonance angiography was performed in patients whose CT angiography was contraindicated. Clinical information, stroke risk factors, and case imaging results were recorded. Stroke time, size, location (cortical, deep lacunar, and white matter), and vascular territory area were evaluated.

Results: The mean age of the 10 patients included in the study was 62±15.10 years. All patients had an ischemic stroke. In total, 4 cases (40%) did not have any risk factors for cerebral vascular disease. Based on DWI results, seven cases were assessed as acute strokes (70%) and three cases as sub-acute strokes (30%). The size of the stroke was 21.80±15.83mm. In 4 cases, the size was extended cortical areas. 3 cases were cortical, 5 cases had a lacunar infarction, 2 cases had cortical and lacunar infarctions. 6 cases were in the posterior cerebral artery territory and 4 cases were in the anterior territory.

Conclusion: The presentation of patients with stroke during COVID-19 therapy or after therapy might be considered the hypothesis that the virus led to a stroke, especially in cases accompanied by risk factors.

Amaç: İnme ile COVID-19 arasındaki ilişkiyi, inme tipleri ve görüntüleme bulguları sunmayı amaçladık.

Gereç ve Yöntem: Mart-Kasım 2020 arasında, inmesi olan (n = 10) COVID-19 teşhisi konulan hastalar retrospektif olarak çalışmaya dahil edildi. İntrakraniyal kanamayı ortadan kaldırmak için tüm hastalara kontrastsız bilgisayarlı tomografi (BT) yapıldı. Daha sonra manyetik rezonans görüntüleme (MRI) ve Difüzyon Ağırlıklı MR (DAG) elde edildi. BT anjiyografisi kontrendike olan hastalara manyetik rezonans anjiyografi yapıldı. Klinik bilgiler, inme risk faktörleri ve görüntüleme sonuçları kaydedildi. İnme süresi, boyutu, konumu (kortikal, derin laküner ve beyaz cevher) ve vasküler bölge alanı değerlendirildi.

Bulgular: Çalışmaya alınan 10 hastanın ortalama yaşı 62±15.10 idi. Tüm hastalarda iskemik inme vardı. Toplamda 4 vakada (%40) serebral vasküler hastalık için herhangi bir risk faktörü yoktu. DAG sonuçlarına göre yedi vaka akut inme (%70) ve üç vaka subakut inme (%30) olarak değerlendirildi. İnme boyutu 21.80±15.83 mm idi. 4 olguda geniş kortikal, 3 olgu kortikal, 5 olguda laküner, 2 olguda kortikal ve laküner enfarktüs vardı. 6 olgu arka serebral arter bölgesinde ve 4 olgu ön serebral bölgede idi.

Sonuç: COVID-19 tedavisi sırasında veya tedaviden hemen sonra inmeli hastaların ortaya çıkması, özellikle risk faktörlerinin eşlik ettiği durumlarda virüsün iskemik inmeye yol açtığı COVID-19 tedavisi sırasında veya tedaviden hemen sonra inmeli hastaların ortaya çıkması, özellikle risk faktörlerinin eşlik ettiği durumlarda virüsün iskemik inmeye yol açtığı hipotezini düşündürmektedir.

  • Ozkan S, Tutar O, Akdeniz YS, Cakmak F, Ipekci A, Biberoglu S. Chest Computed Tomography Findings of Eight Patients With Covid-19 Diagnosis: Case Series. Acta Biomed. 2021 Jan 19;91(4):e2020136.
  • Saggese CE, Del Bianco C, Di Ruzza MR, Magarelli M. COVID-19 and Stroke: Casual or Causal Role? Cerebrovasc Dis 2020;49:341–344.
  • Hamming I, Timens W, Bulthius MLC, Lely AT, Navis GJ, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004; 203 (2): 631-637.
  • Ni W, Yang X, Yang D, et al. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. 2020;24(1):422.
  • Hess DC, Eldahshan W, Rutkowski E. COVID-19-Related Stroke. Translational Stroke Research. 2020 Jun; 11 (3): 322-325.
  • Valderrama EV, Humbert K, Lord, Frontera J, Yaghi S. Severe Acute Respiratory Syndrome Coronavirus2 Infection and Ischemic Stroke. Stroke. 2020; 51:124 -127.
  • Karcıoğlu Ö. Coronavirüs Nedir, Nasıl Korunabiliriz? Phnx Med J. 2020; 2(1): 66-71.
  • Nain Z, Rana HK, Liò P, Islam SMS, Summers MA, Moni MA. Pathogenetic profiling of COVID-19 and SARS-like viruses. Brief Bioinform 2020, (Epub ahead of print).
  • Rascón-Ramírez FJ, Carrascosa-Granada ÁM, Vargas-Jiménez AC, Ferrández-Pujante B, Ortuño-Andériz F. Supra and infratentorial massive strokes in previously healthy young patients with SARS-CoV-2. Neurocirugia (Astur). 2020;doi:10.1016/j.neucir.2020.08.001 (Epub ahead of print)
  • Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis. 2009; 27 (5): 493-501.
  • Ntaios G, Michel P, Georgiopoulos G, et al. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke. 2020 Sep;51(9):e254-e258.
  • Miller EC, Elkind MS. Infection and stroke: an update on recent progress. Curr Neurol Neurosci Rep. 2016; 16: 2.
  • Nagel M, Mahalingam R, Cohrs RJ, Gilden D. Virus vasculopathy and stroke: an under-recognized cause and treatment target. Infect Disord Drug Targets. 2010; 10 (2): 105--11.
  • Wardlaw JM. What causes lacunar stroke? J Neurol Neurosurg Psychiatry. 2005; 76: 617-619.
  • Baudin PN, Caamaño IR, Rubio-Maicas C et al. COVID-19 and Ischemic Stroke: Clinical and Neuroimaging Findings. J Neuroimaging 2020, doi: 10.1111/jon.12790. (Epub ahead of print).
  • Oxley TJ, Mocco J, Majidi S, et al. large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med. 2020; 382: e60.
  • Beyrouti R, Adams ME, Benjamin L, et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry. 2020 Aug;91(8):889-891.
  • Starkey J, Kobayashi N, Numaguchi Y, Moritani J. Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations1. RadioGraphics 2017; 37:562–576.
  • Hernández-Fernández F, Sandoval Valencia H, Barbella-Aponte RA, et al. Cerebrovascular disease in patients with COVID-19: neuroimaging, histological and clinical description. Brain. 2020 Oct 1;143(10):3089-3103.
  • Aydın T, Kesiktaş FN, Çorum M. Analysis of Stroke Patients Requiring Re-hospitalisation for Rehabilitation. Med Bull Haseki 2020;58:422-427.
Primary Language en
Subjects Radiology, Nuclear Medicine, Medical Imaging
Journal Section Research Articles
Authors

Orcid: 0000-0002-4605-6718
Author: Nurdan GOCGUN
Institution: SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL HASEKİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
Country: Turkey


Orcid: 0000-0002-5683-0391
Author: Türkan İKİZCELİ (Primary Author)
Institution: SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL HASEKİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
Country: Turkey


Supporting Institution yok
Project Number Etik Kurul onayı (2021/08)
Dates

Application Date : February 7, 2021
Acceptance Date : February 13, 2021
Publication Date : March 1, 2021

AMA Gocgun N , İkizceli T . Imaging Findings of Ischemic Stroke Associated with COVID-19. Phnx Med J.. 2021; 3(1): 31-34.