Cerebral Vasculitis in a COVID-19 Confirmed Postpartum Patient: A Case Report

Chua, Audrey Marie U.; Jamora, Roland Dominic G.; Jose, Arianne Crizielle E.; Anlacan, Veeda Michelle M.

doi:10.1159/000515815

Cited by 13 publications

(12 citation statements)

References 11 publications

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“…We found vasculitis-like changes included fibrinoid necrosis and inflammation (T lymphocytes, microglia, and macrophages) in multiple vessel walls from one COVID-19-infected brain. This finding is consistent with other neuroimaging studies that reported imaging appearances suggestive of vasculitis in COVID-19 patients, but with lack of pathological confirmation [ 38 – 40 ]. The presence of subacute infarct and white matter changes could be related to complications of cerebral vasculitis in this brain.…”

Section: Discussionsupporting

confidence: 92%

Brain autopsies of critically ill COVID-19 patients demonstrate heterogeneous profile of acute vascular injury, inflammation and age-linked chronic brain diseases

Agrawal

Farfel

Arfanakis

et al. 2022

acta neuropathol commun

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Background This study examined neuropathological findings of patients who died following hospitalization in an intensive care unit with SARS-CoV-2. Methods Data originate from 20 decedents who underwent brain autopsy followed by ex-vivo imaging and dissection. Systematic neuropathologic examinations were performed to assess histopathologic changes including cerebrovascular disease and tissue injury, neurodegenerative diseases, and inflammatory response. Cerebrospinal fluid (CSF) and fixed tissues were evaluated for the presence of viral RNA and protein. Results The mean age-at-death was 66.2 years (range: 26–97 years) and 14 were male. The patient’s medical history included cardiovascular risk factors or diseases (n = 11, 55%) and dementia (n = 5, 25%). Brain examination revealed a range of acute and chronic pathologies. Acute vascular pathologic changes were common in 16 (80%) subjects and included infarctions (n = 11, 55%) followed by acute hypoxic/ischemic injury (n = 9, 45%) and hemorrhages (n = 7, 35%). These acute pathologic changes were identified in both younger and older groups and those with and without vascular risk factors or diseases. Moderate-to-severe microglial activation were noted in 16 (80%) brains, while moderate-to-severe T lymphocyte accumulation was present in 5 (25%) brains. Encephalitis-like changes included lymphocytic cuffing (n = 6, 30%) and neuronophagia or microglial nodule (most prominent in the brainstem, n = 6, 30%) were also observed. A single brain showed vasculitis-like changes and one other exhibited foci of necrosis with ball-ring hemorrhages reminiscent of acute hemorrhagic leukoencephalopathy changes. Chronic pathologies were identified in only older decedents: 7 brains exhibited neurodegenerative diseases and 8 brains showed vascular disease pathologies. CSF and brain samples did not show evidence of viral RNA or protein. Conclusions Acute tissue injuries and microglial activation were the most common abnormalities in COVID-19 brains. Focal evidence of encephalitis-like changes was noted despite the lack of detectable virus. The majority of older subjects showed age-related brain pathologies even in the absence of known neurologic disease. Findings of this study suggest that acute brain injury superimposed on common pre-existing brain disease may put older subjects at higher risk of post-COVID neurologic sequelae.

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Section: Discussionsupporting

confidence: 92%

Brain autopsies of critically ill COVID-19 patients demonstrate heterogeneous profile of acute vascular injury, inflammation and age-linked chronic brain diseases

Agrawal

Farfel

Arfanakis

et al. 2022

acta neuropathol commun

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“…Among the 47 articles identified in our scoping search, several authors report on aneurysmal SAH (aSAH) in the context of COVID-19 [ 31 , 44 , 45 , 46 ] and non-aneurysmal SAH. The latter type of SAH was found eighter in isolation or in the context of other associated pathologies like reversible cerebral vasoconstriction syndrome [ 47 , 48 , 49 ], cerebral venous thrombosis [ 50 ], or intraparenchymal hemorrhage [ 30 , 51 ].…”

Section: Methodsmentioning

confidence: 99%

“…For example, the affinity of SARS-CoV-2 for angiotensin-converting enzyme 2 (ACE-2) receptors, which are expressed in endothelial and arterial smooth muscle cells in the brain, may trigger local inflammation that causes a vasculitic process. Therefore, the viral infection will damage the intracranial arteries, predisposing the vessel wall to rupture, a mechanism that could potentially explain the pathogenesis of hemorrhagic stroke [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Subarachnoid Hemorrhage in Patients with SARS-CoV-2 Infection: Protocol for A Scoping Review

2022

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Subarachnoid hemorrhage (SAH) is a life-threatening condition associated with high mortality and substantial long-term morbidity. The SARS-CoV-2 virus is a new pathogen that causes a disease with variable clinical manifestations. Although the Coronavirus disease 2019 (COVID-19) is associated with hypercoagulopathy, patients may also present with cerebral hemorrhage, including SAH. The present paper reports a protocol for a scoping review that is aimed to provide a comprehensive report on existing literature by examining data on SAH associated with SARS-CoV-2 infection. Our objective is to evaluate the epidemiology, clinical, laboratory, and neuroimaging features of SAH in patients with COVID-19 and to explore the etiology and possible interventions in this pathology. Using appropriate search terms, we will search LitCOVID, the WHO database on COVID-19, and MedRxiv. The inclusion criteria are pre-defined. We will extract the data of eligible studies in standardized forms and will report the results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We will provide information for clinicians, healthcare providers, and public health specialists.

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“…Case reports have shown variable outcomes in pregnant patients with COVID-19 and strokes [ 24 ]. A single case report described cerebral vasculitis (or more likely reversible cerebral vasoconstriction syndrome) in a pregnant patient with COVID-19 who was found to have subarachnoid hemorrhage with complete resolution of symptoms [ 25 ].…”

Section: Stroke Incidence Among Patients With Covid-19mentioning

confidence: 99%

Stroke Treatment in the Era of COVID-19: a Review

Simonetto

Wechsler

Merkler

2022

Curr Treat Options Neurol

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Purpose of Review To describe a comprehensive review of the epidemiology, pathophysiology, and treatment of stroke in the era of COVID-19. Recent Findings COVID-19 is associated with myriad neurological disorders, including cerebrovascular disease. While ischemic stroke is the most common, COVID-19 is associated with an increased risk of intracranial hemorrhage, arterial dissection, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis. In this review, we discuss the epidemiology, pathophysiology, and treatment of stroke due to COVID-19. In addition, we describe how COVID-19 has changed the landscape of stroke systems of care and the effect this has had on patients with cerebrovascular disease. Summary While COVID-19 is associated with a heightened risk of stroke, the pandemic has led to advances in stroke systems of care that may reduce the long-term burden of stroke.

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Cerebral Vasculitis in a COVID-19 Confirmed Postpartum Patient: A Case Report

Cited by 13 publications

References 11 publications

Brain autopsies of critically ill COVID-19 patients demonstrate heterogeneous profile of acute vascular injury, inflammation and age-linked chronic brain diseases

Brain autopsies of critically ill COVID-19 patients demonstrate heterogeneous profile of acute vascular injury, inflammation and age-linked chronic brain diseases

Subarachnoid Hemorrhage in Patients with SARS-CoV-2 Infection: Protocol for A Scoping Review

Stroke Treatment in the Era of COVID-19: a Review

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