COVID-19 Respiratory Illness and Subsequent Cerebrovascular Events, the Initial Iranian Experience

Sabayan, Behnam; Moghadami, Mohsen; Assarzadegan, Farhad; Komachali, Sahar Hojjat Anasri; Poorsaadat, Leila; Babaeepour, Zabihollah; Ebrahimzadeh, Seyed Amir; Hamidi, Ava; Hasheminejad, Zeinab Sadat; Mohammadi-Vosough, Elahe; Mirkarimi, Hamid Reza; Paybast, Sepideh; Rahimian, Nasrin; Safari, Anahid; Sepehrnia, Mersedeh; Nematollahi, Reza; Shahripour, Reza Bavarsad; Batra, Ayush; Sorond, Farzaneh A.; Borhani‐Haghighi, Afshin

doi:10.1016/j.jstrokecerebrovasdis.2020.105454

Cited by 13 publications

(16 citation statements)

References 20 publications

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“…A heterogeneous pattern was also observed in the case series with a pure haemorrhagic presentation (without any concurrent significant ischaemic or encephalopathic features). In the 11 cases presenting with a large haemorrhage, the regions involved were the left temporal lobe (Ghani et al, 2020 ; Hernández-Fernández et al, 2020 ; Sharifi-Razavi et al, 2020 ), the right temporal/insular territory (Benger et al, 2020 ), the temporal lobe bilaterally (Roy-Gash et al, 2020 ), the left frontal lobe (Hernández-Fernández et al, 2020 ), the parietal lobe bilaterally (Sabayan et al, 2021 ), the cerebellum (Al-Dalahmah et al, 2020 ), the basal ganglia (Pavlov et al, 2020 ), and a large portion of the right hemisphere (Keaney and Mumtaz, 2020 ). In one case, the regions affected included the lateral ventricles and the subarachnoid space with no additional details reported (Fan et al, 2020 ).…”

Section: Resultsmentioning

confidence: 99%

Heterogeneity in Regional Damage Detected by Neuroimaging and Neuropathological Studies in Older Adults With COVID-19: A Cognitive-Neuroscience Systematic Review to Inform the Long-Term Impact of the Virus on Neurocognitive Trajectories

Manca

Marco

Ince

et al. 2021

Front. Aging Neurosci.

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Background: Other than its direct impact on cardiopulmonary health, Coronavirus Disease 2019 (COVID-19) infection affects additional body systems, especially in older adults. Several studies have reported acute neurological symptoms that present at onset or develop during hospitalisation, with associated neural injuries. Whilst the acute neurological phase is widely documented, the long-term consequences of COVID-19 infection on neurocognitive functioning remain unknown. Although an evidence-based framework describing the disease chronic phase is premature, it is important to lay the foundations for future data-driven models. This systematic review aimed at summarising the literature on neuroimaging and neuropathological findings in older over-60 patients with COVID-19 following a cognitive neuroscientific perspective, to clarify the most vulnerable brain areas and speculate on the possible cognitive consequences.Methods: PubMed and Web of Science databases were searched to identify relevant manuscripts published between 1st March 2020 and 31th December 2020. Outputs were screened and selected by two assessors. Relevant studies not detected by literature search were added manually.Results: Ninety studies, mainly single cases and case series, were included. Several neuroimaging and neuropathological findings in older patients with COVID-19 emerged from these studies, with cerebrovascular damage having a prominent role. Abnormalities (hyperintensities, hypoperfusion, inflammation, and cellular damage) were reported in most brain areas. The most consistent cross-aetiology findings were in white matter, brainstem and fronto-temporal areas. Viral DNA was detected mainly in olfactory, orbitofrontal and brainstem areas.Conclusion: Studies on COVID-19 related neural damage are rich and diverse, but limited to description of hospitalised patients with fatal outcome (i.e., in neuropathological studies) or severe symptoms (i.e., in neuroimaging studies). The damage seen in this population indicates acute and largely irreversible dysfunction to neural regions involved in major functional networks that support normal cognitive and behavioural functioning. It is still unknown whether the long-term impact of the virus will be limited to chronic evolution of acute events, whether sub-clinical pathological processes will be exacerbated or whether novel mechanisms will emerge. Based on current literature, future theoretical frameworks describing the long-term impact of COVID-19 infection on mental abilities will have to factor in major trends of aetiological and topographic heterogeneity.

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Section: Resultsmentioning

confidence: 99%

Heterogeneity in Regional Damage Detected by Neuroimaging and Neuropathological Studies in Older Adults With COVID-19: A Cognitive-Neuroscience Systematic Review to Inform the Long-Term Impact of the Virus on Neurocognitive Trajectories

Manca

Marco

Ince

et al. 2021

Front. Aging Neurosci.

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“…Cerebrovascular diseases 2 (28.6) (Xiong et al, 2020;Tiwari et al, 2021) 3 (13.6) (Asif and O' Mahony, 2020;Gulko et al, 2020;Dakay et al, 2021) 3 (15.8) (Cavalcanti et al, 2020;de Sousa et al, 2020;Dakay et al, 2021) 19 (31.7) (Al Saiegh et al, 2020;Cavalcanti et al, 2020;Cezar-Junior et al, 2020;Chia et al, 2020;Diaz-Segarra et al, 2020;Fara et al, 2020;Kantonen et al, 2020;Oxley et al, 2020;Pisano et al, 2020;Trifan et al, 2020a,b;Vu et al, 2020;Wang et al, 2020;Al-Mufti et al, 2021;Sabayan et al, 2021;Shah et al, 2021) 31 (43.1) (Agarwal et al, 2020;Anzalone et al, 2020;Cavalcanti et al, 2020;de Almeida Lima et al, 2020;Fabbri et al, 2021;Gupta et al, 2020;Heman-Ackah et al, 2020;Lapergue et al, 2020;Nicholson et al, 2020;Oxley et al, 2020;Patel et al, 2020;…”

Section: Age-associated Neurological Complications Of Covid-19unclassified

Age-Associated Neurological Complications of COVID-19: A Systematic Review and Meta-Analysis

Sullivan

Fischer

2021

Front. Aging Neurosci.

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The outbreak of the novel and highly infectious severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in hundreds of millions of infections and millions of deaths globally. Infected individuals that progress to coronavirus disease-19 (COVID-19) experience upper and lower respiratory complications that range in severity and may lead to wide-spread inflammation and generalized hypoxia or hypoxemia that impacts multiple organ systems, including the central and peripheral nervous systems. Since the SARS-CoV-2 outbreak, multiple reports continue to emerge that detail neurological symptoms, ranging from relatively mild (e.g., impaired taste and/or smell) to severe (e.g., stroke), suggesting SARS-CoV-2 may be neurotropic and/or contribute to nervous system injury through direct and/or indirect mechanisms. To gain insight into the types of neurological complications associated with SARS-CoV-2 infection and their possible relationship with age, sex, COVID-19 severity, and comorbidities, we performed a systematic review of case reports and series published in 2020 – April 4, 2021 of infected patients with neurological manifestations. Meta-analyses were conducted using individual patient data from reports where these data could be extracted. Here, we report neurological injury occurs across the lifespan in the context of infection, with and without known comorbidities, and with all disease severities, including asymptomatic patients. Older individuals, however, are more susceptible to developing life-threatening COVID-19 and cerebrovascular disease (CVD), such as stroke. A mild but inverse correlation with age was seen with CNS inflammatory diseases, such as encephalitis, as well as taste and/or smell disorders. When reported, increased age was also associated with comorbid cardiovascular risk factors, including hypertension, diabetes mellitus, and lipid disorders, but not with obesity. Obesity did correlate with development of critical COVID-19. Discussion into potential pathophysiological mechanisms by which neurological symptoms arise and long-term consequences of infection to the nervous system is also provided.

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“…[14] Our patient did not have any single modifiable or non-modifiable risk factor except sex. [11] Weakness, dry cough and impaired consciousness SAH in bilateral parasagittal areas originating from Willis polygon Not reported COVID-19 associated pneumonia; death 60/man [25] Chest pain, headache and confusion SAH with intraventricular hemorrhage Blood pressure control / calcium channel blocker Death Two cases: [26] ( Case series (four casesone man and three women) [10] Fever, cough, anosmia, headache, dyspnea and myalgia 56/man [20] Dyspnea and hypoxic respiratory failure Small diffuse bilateral fronto-parietal and intraventricular hemorrhage Unfractionated heparin and extracorporeal membrane oxygenation Pulmonary embolism; discharged with stable hemodynamic and neurological status 66/woman [30] Post-cardiac arrest with return of spontaneous circulation. Oneweek history of dry cough, shortness of breath and general malaise…”

Section: Discussionmentioning

confidence: 99%

Non-Aneurysmal Subarachnoid Hemorrhage in COVID-19: A Case Report and Review of Literature

Ray

Roy

Ghosh

et al. 2022

MRAJ

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Background: Hemorrhagic cerebrovascular events, either due to aneurysmal rupture or spontaneous subarachnoid hemorrhage (SAH), are not rare in COVID-19. Several mechanisms such as coagulopathy, cytokine storm, viral endotheliopathy, hypertension, and immune modulation might play a role in the pathogenesis of SAH in COVID-19. This study aimed to report the first case of spontaneous non-aneurysmal SAH associated with SARS-CoV-2 from India. We briefly discussed the possible pathogenetic mechanisms underlying this process and succinctly reviewed the relevant literature. Case report: We herein report a case of a non-comorbid young woman infected with SARS-CoV-2 presenting with thunderclap headache and eventually non-aneurysmal SAH, who recovered with conservative management. Conclusion: Headache, although a very common clinical feature of COVID-19 itself, must be investigated in detail to identify alternate causes that may be life-threatening. This case also incites further enquiry into the possible pathogenic mechanisms of neurovascular complications in COVID-19.

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COVID-19 Respiratory Illness and Subsequent Cerebrovascular Events, the Initial Iranian Experience

Abstract: Highlights The majority of patients with stroke and COVID-19 had vascular risk factors. Stroke and COVID-19 might be associated with severe disability and death. There might be major disruptions in investiagtions needed for stroke.

Cited by 13 publications

References 20 publications

Heterogeneity in Regional Damage Detected by Neuroimaging and Neuropathological Studies in Older Adults With COVID-19: A Cognitive-Neuroscience Systematic Review to Inform the Long-Term Impact of the Virus on Neurocognitive Trajectories

Heterogeneity in Regional Damage Detected by Neuroimaging and Neuropathological Studies in Older Adults With COVID-19: A Cognitive-Neuroscience Systematic Review to Inform the Long-Term Impact of the Virus on Neurocognitive Trajectories

Age-Associated Neurological Complications of COVID-19: A Systematic Review and Meta-Analysis

Non-Aneurysmal Subarachnoid Hemorrhage in COVID-19: A Case Report and Review of Literature

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