COVID-19 Associated Reversible Cerebral Vasoconstriction Syndrome Successfully Treated with Nimodipine and Aspirin

Mansoor, Tarab; Alsarah, Ali A.; Mousavi, H A Ebrahimzadeh; Eliyas, Javed Khader; Girotra, Tarun; Hussein, Omar

doi:10.1016/j.jstrokecerebrovasdis.2021.105822

Cited by 25 publications

(28 citation statements)

References 5 publications

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“…The remaining 34 articles, including case reports, case series, letters to the editor, pictorial essays etc. reporting cases of PRES in COVID-19 were finally shortlisted after rigorous screening [ [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] ]. Since a total of 31 patients were described in the nine case series, individual data of 56 patients is described in our systematic review in the form of two tables [ Table 1 and Table 2 ].…”

Section: Resultsmentioning

confidence: 99%

“… – – 19 Mohamed Elhassan et al (2021) [ 30 ] T1: Symmetric WMH in the bilateral occipital lobe cortex Relative hypodensities posteriorly – 20 Tarab Mansoor et al (2021) [ 31 ] T2-FLAIR: WMH in the parietooccipital the frontal lobes. No signs of intracranial hemorrhage or ischemia CTA: beading pattern mainly in the basilar artery, CTV: Unremarkable 21 Fabio Noro et al (2021) [ 32 ] – Areas of bilateral parieto-occipital hypodensity – 22 Ali Kerro (2021) [ 33 ] FLAIR: Normal. DWI, ADC: Negative Hypodensities in the right cerebellar hemisphere and bilateral subcortical occipital lobe – 23 Ahmad J. Abdulsalam et al (2021) [ 34 ] T2 FLAIR: asymmetrical bilateral posterior parieto-occipital, centrum semi ovale and corona radiata WMH and features of vasogenic edema Asymmetrical hypodensity within the bilateral parieto-occipital WM ‘- 24 Louis Kishfy et al (2020) [ 35 ] T2 FLAIR: subcortical WMH of occipital and posterior temporal lobes with effacement of adjacent sulci.…”

Section: Resultsmentioning

confidence: 99%

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The association of posterior reversible encephalopathy syndrome with COVID-19: A systematic review

Iftikhar¹,

Rehman²,

Ameer³

et al. 2021

Annals of Medicine and Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The association of posterior reversible encephalopathy syndrome with COVID-19: A systematic review

Iftikhar¹,

Rehman²,

Ameer³

et al. 2021

Annals of Medicine and Surgery

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“…Second, vasculitis is seen in cerebral vessels of patients with SARS-CoV-2, which can explain endothelial damage and vasoconstriction leading to CV (10). Third, a reversible vaso-constriction syndrome (RCVS) of cerebral arteries has been described (11,12). Another patient succumbed to a devastating diffuse arterial and dural venous sinus construction with generalized cerebral edema four days after admission (13).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intracerebral Hemorrhage and Delayed Cerebral Vasospasm in a Patient with COVID-19 Infection

2021

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Introduction: The SARS-CoV-2 may cause vasculitis and thromboembolic events. We report on an unusual case of spontaneous intracerebral hemorrhage and delayed cerebral vasospasms in a patient with COVID-19. Case Presentation: A 65-year-old male was transferred to the emergency department due to a short period of unconsciousness. Twenty-two hours prior to presentation, the patient had a 39.5°C fever with breathing difficulties. Initial COVID-19 PCR was positive. While conscious and without any neurological impairment, a large right frontal intracerebral hemorrhage (ICH) was detected. A preoperative angiogram showed no pathological blood vessels or vasospasm. The patients had a generalized tonic-clonic seizure due to ICH progression, which led to an immediate microsurgical ICH removal. Thirteen days thereafter, the patient became unconscious again. Angiography revealed severe cerebral vasospasm (CV) that required repetitive percutaneous transluminal angioplasty (PTA) and intra-arterial nimodipine treatment. Conclusions: We present the first case of ICH and delayed vasospasm associated with COVID-19. In these patients, combined maximum surgical and endovascular therapy is needed.

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“…This syndrome is quite rare in children, particularly young children, and has only been reported in case reports or very small case series [ 6 ]. Recently two adult case reports have been published which reported RCVS in COVID-19 patients [ 7 , 8 ]. This paper reports two pediatric COVID-19 patients with severe MIS-C in association with thunderclap headaches and findings of RCVS.…”

Section: Introductionmentioning

confidence: 99%

Reversible Cerebral Vasoconstriction Syndrome and Multisystem Inflammatory Syndrome in Children With COVID-19

Sadeghizadeh

Pourmoghaddas

Zandifar

et al. 2022

Pediatric Neurology

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Background Multi-system inflammatory syndrome in children (MIS-C) involves multiple organs and shows increased inflammatory markers. Since the onset of the COVID-19 pandemic, several studies have reported the association between severe COVID-19 and MIS-C. Reversible cerebral vasoconstriction syndrome (RCVS) presents with thunderclap headaches and multifocal reversible vasoconstriction on imaging. RCVS is very rare in children. This paper reports two cases of pediatric COVID-19 with severe MIS-C and clinical and imaging features indicative of RCVS. Methods Clinical, laboratory and imaging data of the patients were reviewed. The diagnosis of RCVS was confirmed based on clinical symptomatology and brain magnetic resonance imaging findings. Results Two pediatric patients with clinical findings compatible with severe MIS-C and hemodynamic compromise presented to the hospital. During their hospitalization course, they developed thunderclap headaches and neurological deficits. Both were receiving vasoactive agents, intravenous immune globulin (IVIG), and immunosuppressants. Imaging studies showed marked multifocal cerebral vasoconstriction in both cases and infarcts in one. The course and management of the patients will be presented. After controlling inflammation and elimination of triggers, both patients were ultimately symptom-free upon discharge. Cerebral vasoconstriction had completely resolved on follow-up imaging. Conclusions Although a variety of symptoms including headaches may be seen in pediatric COVID-19 patients with MIS-C, RCVS should be considered as a differential diagnosis in cases of thunderclap headache accompanied by neurologic signs in these patients. Imaging findings and follow-up are also key in establishing the diagnosis.

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COVID-19 Associated Reversible Cerebral Vasoconstriction Syndrome Successfully Treated with Nimodipine and Aspirin

Cited by 25 publications

References 5 publications

The association of posterior reversible encephalopathy syndrome with COVID-19: A systematic review

The association of posterior reversible encephalopathy syndrome with COVID-19: A systematic review

Spontaneous Intracerebral Hemorrhage and Delayed Cerebral Vasospasm in a Patient with COVID-19 Infection

Reversible Cerebral Vasoconstriction Syndrome and Multisystem Inflammatory Syndrome in Children With COVID-19

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