Case 26-2020: A 60-Year-Old Woman with Altered Mental Status and Weakness on the Left Side

Singhal, Aneesh B.; González, R Gilberto; Chwalisz, Bart K; Mukerji, Shibani S.

doi:10.1056/nejmcpc2004976

Cited by 15 publications

(7 citation statements)

References 61 publications

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“…The mechanism might be that SARS-COV-2 directly penetrates the endothelial cells of cerebral cortical arterioles, thereby inducing direct or immune-mediated damage [ 108 ]. There are also reports of small ischemic stroke [ 115 ], which could be caused by viral cerebral microvascular endotheliitis or systemic inflammation [ 116 ].…”

Section: Resultsmentioning

confidence: 99%

The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on ischemic stroke and the possible underlying mechanisms

Song

Fan

Tang

et al. 2021

International Journal of Neuroscience

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Purpose: As of November 28, 2020, COVID-19 has been reported in 220 countries with 61,036,793 confirmed cases and 1,433,316 confirmed deaths; countries became vigilant around the world. In addition to SARS-CoV-2 causing pneumonia, many studies have reported ischemic stroke in patients with COVID-19. This article describes the effects and possible underlying mechanisms of SARS-CoV-2 on ischemic stroke. Materials and methods: A literature search was performed using PubMed, Web of Science, and other COVID-dedicated databases and the combination of the keywords ‘SARS-CoV-2’, ‘COVID-19’ and ‘ischemic stroke’ up to November 28, 2020. Results: SARS-CoV-2 invades the host through angiotensin converting enzyme 2 (ACE2). ACE2 is expressed not only in the lungs, but also in the brain and vascular endothelial cells. SARS-CoV-2 infection might cause direct vascular disease or enhance the immunogenic thrombosis environment through several mechanisms. SARS-CoV-2 infection can modulate the host immune response and can cause inflammation, coagulation disorders, renin angiotensin system disorders, hypoxia, and stress disorders, which may lead to the occurrence of ischemic stroke. Conclusions: Some patients with COVID-19 can develop ischemic stroke. Ischemic stroke has a high risk of causing disability and is associated with a high mortality rate. It is hoped that when medical staff treat patients with COVID-19, they would pay attention to the occurrence of ischemic stroke to improve the prognosis of patients with COVID-19.

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Section: Resultsmentioning

confidence: 99%

The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on ischemic stroke and the possible underlying mechanisms

Song

Fan

Tang

et al. 2021

International Journal of Neuroscience

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“…[3] IMT involvement of the CNS (IMT-CNS) is a rare occurrence, with a total number of sporadic IMT-CNS reported of less than 100. [14,22,23] When confined to the intracranial vault, it is classified as intraparenchymatous, meningeal, mixed intraparenchymatous, and meningeal, and extending to the cranial cavity/sphenoid sinus. [11] Meningeal lesions represent the most common subtype, frequently presenting with headache or seizure.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory myofibroblastic tumor masquerading as an anterior choroidal artery fusiform aneurysm

Malnik

Moor

Shin

et al. 2021

Surgical Neurology International

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Background: Inflammatory myofibroblastic tumor is a rare, poorly understood tumor that has been found to occur in almost every organ tissue. Its location within the central nervous system is uncommon, and patients tend to present with nonspecific symptoms. Case Description: A female in her eighth decade presented to neurosurgery clinic with complaints of headache and dizziness. Initial imaging was consistent with a low-grade, benign brain lesion in the region of the left choroidal fissure. She was recommended for observation but returned 1 month later with progressive symptoms and doubling of the lesion size. She underwent surgical resection and was found to have an IMT arising from the wall of the left anterior choroidal artery. Conclusion: Intracranial IMT remains a rare and poorly understood entity. The present case demonstrates a novel presentation of IMT in an adult patient and exemplifies the heterogeneity of the disease presentation.

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“…One also wonders whether endothelialitis is being generated more selectively in the cerebral circulation in these patients and they are generating in situ thrombosis. 54,55 Another possibility is that the virus is binding more to ACE2 brain receptors than lung receptors leading to more unopposed ACEI activity which may be expressing itself more in the brain than elsewhere in these patients.…”

Section: The Role Of Antiphospholipid Antibody In Covid-19 Coagulopathymentioning

confidence: 99%

COVID-19 and Its Implications for Thrombosis and Anticoagulation

Berkman

Tapson

2021

Semin Respir Crit Care Med

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Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in extracorporeal membrane oxygenation (ECMO) devices, acute limb ischemia, and isolated strokes, all in the face of prophylactic and even therapeutic anticoagulation, are features of novel coronavirus disease 2019 (COVID-19) coagulopathy. It seems well established at this time that a COVID-19 patient deemed sick enough to be hospitalized, should receive at least prophylactic dose anticoagulation. However, should some hospitalized patients have dosage escalation to intermediate dose? Should some be considered for full-dose anticoagulation without a measurable thromboembolic event and how should that anticoagulation be monitored? Should patients receive postdischarge anticoagulation and with what medication and for how long? What thrombotic issues are related to the various medications being used to treat this coagulopathy? Is antiphospholipid antibody part of this syndrome? What is the significance of isolated ischemic stroke and limb ischemia in this disorder and how does this interface with the rest of the clinical and laboratory features of this disorder? The aims of this article are to explore these questions and interpret the available data based on the current evidence.

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Case 26-2020: A 60-Year-Old Woman with Altered Mental Status and Weakness on the Left Side

Cited by 15 publications

References 61 publications

The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on ischemic stroke and the possible underlying mechanisms

The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on ischemic stroke and the possible underlying mechanisms

Inflammatory myofibroblastic tumor masquerading as an anterior choroidal artery fusiform aneurysm

COVID-19 and Its Implications for Thrombosis and Anticoagulation

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