Клинико-патогенетические особенности церебрального инсульта у больных с новой коронавирусной инфекцией (COVID-19) 1 Санкт-Петербургское государственное бюджетное учреждение здравоохранения «Городская многопрофильная больница ¹ 2»,

Introduction. The COVID-19 impact on hemostasis of stroke survivors with community-acquired pneumonia is an urgent problem. The aim of the study is to analyze the features of clinical and laboratory parameters in cerebral stroke combined with community-acquired pneumonia caused by the SARS-Co-V-2 virus. Materials and methods. The instrumental and laboratory examination results of 88 patients aged 73.0 (12.3) years in the acute period of stroke with community-acquired viral pneumonia symptoms were analyzed. The present study included 39.8 % (n=53) male and 60.2 % female (n=35) with duration of diagnosed infectious disease less than 7 days. The symptoms of cerebral stroke were compared with the results of laboratory testing of the hemostasis system, lipid metabolism, and the activity of the systemic inflammatory response. The severity of lung tissue damage and the outcomes of the diagnosed changes were assessed. Results. All patients had mild or moderate COVID-19. In 87.5 % (n=77) cases unspecified (40.2 %, n=31), cardioembolic (36.4 %, n=28), lacunar (3.9 %, n=3) and atherothrombotic (19.5 %, n=15) ischemic stroke subtype was diagnosed. Focal ischemia lesion in the left middle cerebral artery (LMCA) territory was detected in 45.6 % (n=35), in the right middle cerebral artery (RMCA) territory in 41.6 % (n=32). Manifestations of hemorrhagic stroke were noted in 12.5 % (n=11) with signs of parenchymal hemorrhage in 54.5 % (n=6), ventricular hemorrhage in 27.3 % (n=3), subarachnoid hemorrhages were noted in 18.2 % (n=2). The indicators of the coagulation system in terms of the number of platelets corresponded to 251.3 (90.7); the APTT value was in the range of 29.2 (26.7 33.0) (s); the INR parameter was 1.16 (1.05 1.25); the value of prothrombin ( %) corresponded to the value of 85.9(23.4). Conclusion. We do not observe the great disorders of haemostasis in the most acute period of the stroke. When combined with COVID-19 the most common stroke is ischemic stroke. The stroke survivors with the community-acquired pneumonia caused by SARS-CoV-2 laboratory tests show that increase of inflammatory markers are above the reference range.

Objective: To improve the diagnosis and treatment of acute cerebrovascular accident in patients with community-acquired pneumonia caused by the novel coronavirus infection (COVID-19). Materials and methods: For the first time, clinical manifestations of strokes in patients with diagnosed new coronavirus infection (COVID-19) were analyzed in 130 patients. The study was conducted in two groups. The main group consisted of 69,2 % (n = 90) with a clinical and instrumental diagnosis: novel coronavirus infection in combination with stroke. The control group (30,8 %; n = 40) included the cases of ischemic and hemorrhagic stroke without signs of SARS-CoV-2. In both groups, the severity of the disease and pathogenetic subtypes were compared, and the features of the laboratory biochemical data were studied. Statistical analysis of the outcomes was carried out taking into account the severity of brain and lung tissue damage. Results: In patients with cerebral stroke against the background of the new coronavirus infection (COVID-19), the prevalence of ischemic stroke cases (86,4 %) was noted for undetermined (41,4 %) and cardioembolic (35,7 %) pathogenetic subtypes (according to TOAST) with localization in the carotid basin (89,7 %). In hemorrhagic stroke, parenchymal hemorrhage was observed with a greater frequency (54,5 %). The severity of the diagnosed strokes according to the NIHSS scale was up to 13,16 (8,80) points with less severe brain damage — Glasgow coma scale (14,0 (12,0 15,0). In the group of the patients, a widespread lesion of the lung tissue was diagnosed in 82,2 % of cases. No significant increase in the incidence of clinically significant manifestations of systemic and organ hypercoagulation was established. Conclusions: In stroke patients with COVID-19, ischemic manifestations with undetermined and cardioembolic subtypes without age and gender features prevail, with no differences in the severity of the course and a large number of favorable outcomes. A high activity of inflammatory and infectious changes was established by clinical laboratory.