Massive bilateral stroke in a COVID-19 patient

Mohamed, Iskandar Zulqarnain bin; Balson, Laura; Madathil, Shyam

doi:10.1136/bcr-2020-236254

Cited by 13 publications

(8 citation statements)

References 13 publications

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“…For example, delirium was not associated with specific neuroimaging findings: Helms et al (2020b) observed this symptom in people with WM damage, fronto-temporal hypoperfusion, stroke, and haematomas, while other patients with delirium had no MRI abnormalities at all (Paterson et al, 2020). Decline in, or loss of, consciousness was also reported in patients with right frontal ischaemia (Basi et al, 2020), right temporal haemorrhage (Sharifi-Razavi et al, 2020), lesions of the left midbrain (Fan et al, 2020) and of the left ventromedial prefrontal cortex (Muhammad et al, 2020), extensive right-sided (Fan et al, 2020) or left-sided lesions (Mohamed et al, 2020), diffuse WM lesions (McCuddy et al, 2020;Muccioli et al, 2020), diffuse cerebrovascular alterations (Pugin et al, 2020) and also in the absence of MRI abnormalities (Manganelli et al, 2020;Mohamud et al, 2020). Similarly, altered mental status was observed in patients with one lesion in the splenium (Sparr and Bieri, 2020), scattered WM lesions (Farhadian et al, 2020), and microbleeds (Fitsiori et al, 2020), in a case with haemorrhage in the right parieto-occipital territory (Franceschi et al, 2020), but in most cases alterations in mental state were not associated with any specific MRI finding (Radmanesh et al, 2020a,b).…”

Section: Cognitive Correlates Of Neuroimaging Findingsmentioning

confidence: 97%

“…A sixth patient showed numerous hyperintensities, leukoaraiosis in the right intraparietal sulcus and microhaemorrhages in the left centrum semiovale, thalamus, left cerebellum and left anterior temporal lobe (Jaunmuktane et al, 2020). A seventh patient presented with bilateral ischaemic-haemorrhagic infarctions affecting, above all, a large proportion of the left hemisphere from frontal to occipital regions (Mohamed et al, 2020). An eight patient had several ischaemic regions scattered across his white matter including the cerebellum, deep white matter and centri semiovale, with a concomitant lenticular haemorrhage (Hanafi et al, 2020).…”

Section: Mixed Ischaemia and Haemorrhage Patternmentioning

confidence: 99%

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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: Cognitive Correlates Of Neuroimaging Findingsmentioning

confidence: 97%

Section: Mixed Ischaemia and Haemorrhage Patternmentioning

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.

View full text Add to dashboard Cite

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“…As a comparartor, data from 2009 study in Seoul prior to COVID 19 reported ischemic stroke complicating 0.04% to 0.06% of hospital admissions for all clinical presentations. Mohamed IZ et al [10] and this deserves special attention. Sensitivity of COVID-19 PCR by nasal swab is 70% and specificity is 90% and this is the reason that the test needs to be repeated in strongly suspected cases as was true in our case [11].…”

Section: Discussionmentioning

confidence: 89%

Acute Ischemic Stroke in COVID-19 Patient with Lung Collapse: A Case Report

Nawazish

Iqbal

Butt

2021

AJRID

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Novel corona virus 2019 also known as severe acute respiratory syndrome coronavirus 2 [SARS COV2] is enveloped non segmented ribonucleic acid (RNA) virus. Acute ischemic stroke remains emergency during covid19 pandemic [1] Here we present a case of a woman with COVID 19 who presented to us with symptoms of altered state of consciousness (ASOC), cough, fever, dysarthria, right sided body weakness and massive bilateral middle cerebral artery (MCA)/ anterior. Our case was unique in the sense that it showed drastic central nervous system (CNS) damage in the presence of coronavirus infection. There are a few cases of patients who develop stroke after COVID 19 infection. Aims: Clinicians need to be aware of possible causes of unconsciousness in coronavirus disease (COVID 19) patients, particularly as delirium appears to be common complications to find out the association between stroke and COVID 19 and its impact and mortality. Case Presentation: A 70 years old lady presented to us with symptoms of stroke like ASOC, right sided body weakness, dysarthria, and symptoms of pneumonia like mild cough and fever later which turned out to be COVID 19. Clinicians need to be aware of possible causes of unconsciousness in coronavirus disease (COVID 19) patients, particularly as delirium appears to be common complications to find out the association between stroke and COVID 19 and its impact and mortality. Discussion: Bilateral ischemic stroke is relatively uncommon presentation in general population and is usually the result of cardio embolic cause such as atrial fibrillation and recent myocardial infarction. While this patient had pre existing risk factors for stroke such as type 2 diabetes mellitus, hypertension and old age and her electrocardiography showed sinus rhythm. Conclusion: COVID-19 may be a risk factor or aggravating factor for stroke.

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“…Although not completely understood, the plausible proposed mechanism of cerebrovascular disease in COVID-19 includes viral neurotropism, coagulopathy from systemic inflammation and cytokine storm, and endothelial dysfunction leading to angiopathic thrombosis. There have been a handful of cases linking COVID-19 to large vessel macrothrombosis and antiphospholipid syndrome [ 4 ]. We reported an even more unusual case that presented with multiple focal neurologic symptoms and was found to have watershed infarctions secondary to COVID-19 with only mild respiratory symptoms, and without typical vascular risk factors, PFO or arrhythmia, after excluding autoimmune diseases, hypercoagulability diseases, and vasculitis; this report highlights the importance of suspecting this devastating disease in an otherwise healthy young patient who presents with focal neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

Acute Multiple Cerebral Watershed Infarctions as the Initial Presentation of COVID-19 in a Young Male Patient: A Case Report

Abdelmasih¹,

Abdelmaseih²,

Oleo³

2021

Cureus

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Cerebrovascular diseases appear to be one of the most serious complications of coronavirus disease 2019 . In this report, we present a case of a 38-year-old male with a past medical history significant only for hypertension, who presented to the emergency department (ED) with confusion and multiple focal neurologic deficits. Brain imaging showed acute multiple cerebral watershed infarctions. Upon further investigation and laboratory workup, the hypercoagulability and vasculitis panels were found to be negative, and other differential diagnoses were ruled out. In light of a number of emerging reports of COVID-19related ischemic stroke, our patient was also screened for the disease, and surprisingly the test came back positive. We believe this case report will highlight the importance of conducting neurological examinations in COVID-19 patients, since timely workup and prompt interventions may reduce morbidity and mortality.

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Massive bilateral stroke in a COVID-19 patient

Cited by 13 publications

References 13 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

Acute Ischemic Stroke in COVID-19 Patient with Lung Collapse: A Case Report

Acute Multiple Cerebral Watershed Infarctions as the Initial Presentation of COVID-19 in a Young Male Patient: A Case Report

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