Large vessel stroke and COVID-19: Case report and literature review

Mahboob, Sumaiya; Boppana, Sri Harsha; Rose, Nicholas B.; Beutler, Bryce D.; Tabaac, Burton J.

doi:10.1016/j.ensci.2020.100250

Cited by 20 publications

(16 citation statements)

References 10 publications

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“…Ischemic lesions were located in both large and small vessels, such as middle cerebral artery ( 23 – 26 ), anterior cerebral artery ( 24 ), posterior inferior cerebellar artery ( 26 , 27 ), pericallosal artery ( 28 ), lenticulostriate artery ( 26 ), etc. Anterior circulation artery involvement accounted for 69.2% in acute/subacute infarctions according to an American study ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Insights Into Neuroimaging Findings of Patients With Coronavirus Disease 2019 Presenting With Neurological Manifestations

Chen

Zheng

et al. 2020

Front. Neurol.

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Section: Discussionmentioning

confidence: 99%

Insights Into Neuroimaging Findings of Patients With Coronavirus Disease 2019 Presenting With Neurological Manifestations

Chen

Zheng

et al. 2020

Front. Neurol.

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“…The highly contagious severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes a cardiorespiratory disease identified as COVID-19, which has resulted in a global pandemic in 2020. Although the primary target of SARS-CoV-2 is the respiratory system, an increasing percentage of COVID-19 patients present neurological symptoms including anosmia, ageusia, encephalitis, seizures, and stroke ( Baig and Sanders, 2020 , Efe et al, 2020 , Finsterer and Stollberger, 2020 , Fotuhi et al, 2020 , Gilani et al, 2020 , Heneka et al, 2020 , Liang et al, 2020 , Liguori et al, 2020 , Mahboob et al, 2020 , Montalvan et al, 2020 ; Morgello, S., 2020; Moriguchi et al, 2020 , Parsons et al, 2020 , Saggese et al, 2020 , Wu et al, 2020 ). A comprehensive understanding of the mechanisms by which SARS-CoV-2 causes neurological symptoms is currently lacking.…”

Section: Role Of Astroglial Tlrs In Viral Infections Of the Cnsmentioning

confidence: 99%

Role of astroglial toll-like receptors (TLRs) in central nervous system infections, injury and neurodegenerative diseases

Acıoğlu

Heary

et al. 2021

Brain, Behavior, and Immunity

191

129

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Highlights Astroglial TLRs mediate host-defense and pathogen dissemination in CNS infections. Astroglial TLRs help clearance of protein aggregates in neurodegenerative diseases. Astroglial TLR signaling contributes to inflammation in CNS injury and disease. Signaling through TLRs promotes beneficial and detrimental functions of astrocytes. TLRs in astrocytes could be therapeutic targets in CNS disease and injury.

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“…COVID-19 patients have been shown to suffer a hypercoagulable state, increasing the risk of acute ischemic strokes, probably because some procoagulant and inflammatory pathways are activated. Mahboob et al ( 10 ) suggested that antibody screening and immediate prophylactic anticoagulation may have reduced the risk of those events. In our case however, we did not find major risk factors for cerebrovascular disease, and antiphospholipid antibodies and the rest of the procoagulant tests were negative.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Decompressive Craniectomy for COVID-19 Malignant Cerebral Artery Infarction. Is Surgery a Good Option?

et al. 2021

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SARS-CoV2 infection can lead to a prothrombotic state. Large vessel occlusion, as well as malignant cerebral stroke have been described in COVID-19 patients. In the following months, given the increase in COVID-19 cases, an increase in malignant cerebral SARS-CoV2 associated strokes are expected. The baseline situation of the patients as well as the risk of evolution to a serious disease due to the virus, depict a unique scenario. Decompressive craniectomy is a life-saving procedure indicated in patients who suffer a malignant cerebral stroke; however, it is unclear whether the same eligibility criteria should be used for patients with COVID-19. To our knowledge seven cases of decompressive craniectomy and malignant cerebral stroke have been described to date. We report on a 39-year-old female with no major risk factors for cerebrovascular disease, apart from oral contraception, and mild COVID-19 symptoms who suffered from left hemispheric syndrome. The patient underwent endovascular treatment with stenting and afterward decompressive craniectomy due to a worsening neurological status with unilateral unreactive mydriasis. We present the case and provide a comprehensive review of the available literature related to the surgical treatment for COVID-19 associated malignant strokes, to establish whether the same eligibility criteria for non-COVID-19 associated strokes should be used. Eight patients, including our case, were surgically managed due to malignant cerebral stroke. Seven of these patients received decompressive craniectomy, and six of them met the eligibility criteria of the current stroke guidelines. The mortality rate was 33%, similar to that described in non-COVID-19 cases. Two patients had a left middle cerebral artery (MCA) and both survived after decompressive craniectomy. Our results support that decompressive craniectomy, using the current stroke guidelines, should be considered an effective life-saving treatment for COVID-19-related malignant cerebral strokes.

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Large vessel stroke and COVID-19: Case report and literature review

Cited by 20 publications

References 10 publications

Insights Into Neuroimaging Findings of Patients With Coronavirus Disease 2019 Presenting With Neurological Manifestations

Insights Into Neuroimaging Findings of Patients With Coronavirus Disease 2019 Presenting With Neurological Manifestations

Role of astroglial toll-like receptors (TLRs) in central nervous system infections, injury and neurodegenerative diseases

Case Report: Decompressive Craniectomy for COVID-19 Malignant Cerebral Artery Infarction. Is Surgery a Good Option?

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