Multiple internal border zone infarcts in a patient with COVID-19 and CADASIL

Williams, Owain; Mohideen, Saamir; Sen, Arup; Martinovic, Olivera; Hart, Jonathan; Brex, Peter; Sztriha, L.

doi:10.1016/j.jns.2020.116980

Cited by 28 publications

(26 citation statements)

References 10 publications

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“…To date there are several reports on neurological complications of COVID-19. We divided the neurological symptoms in such patients into three different groups: symptoms related to CNS involvement [ [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , [98] , [99] , [100] , [101]...…”

Section: Resultsmentioning

confidence: 99%

“… Cerebrovascular events 3 Ischemic Stroke 37 Articles [ 39 ], [ 57 ], [ 58 ], [ 60 ], [ 63 ], [ 73 ], [ 74 ], [ 75 ], [ 76 ] [ 77 ], [ 78 ], [ 79 ], [ 80 ],. [ 81 ], [ 82 ], [ 83 ], [ 84 ], [ 85 ], [ 86 ], [ 87 ], [ 88 ], [ 89 ], [ 90 ], [ 91 ], [ 92 ], [ 93 ], [ 94 ], [ 95 ], [ 96 ], [ 97 ], [ 98 ], [ 99 ], [ 100 ], [ 101 ], [ 102 ], [ 178 ], [ 192 ] 363 NR in all articles. In large population studies ischemic stroke was reported in 1% [ 77 ] to 2.5% [ 84 ] of patients.…”

Section: Resultsmentioning

confidence: 99%

“…Ischemic Stroke 37 Articles [39], [57], [58], [60], [63], [73], [74], [75], [76] [77], [78], [79], [80],. [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100], [101], [102], [178], [192] 363 NR in all articles.…”

Section: Cerebrovascular Eventsmentioning

confidence: 96%

See 2 more Smart Citations

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Dorche

Huot

Osherov

et al. 2020

Journal of the Neurological Sciences

186

182

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Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications. Methods: This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19. Results: Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported. Conclusion: There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Dorche

Huot

Osherov

et al. 2020

Journal of the Neurological Sciences

186

182

View full text Add to dashboard Cite

show abstract

“…Both thrombotic microangiopathy related to direct or indirect damage by SARS-CoV-2 on the endothelium of cerebral small vessels and brain-blood-barrier injury related to hypoxemia have been hypothesized. An emblematic case of the possible causality of the association between COVID-19 and IS in a patient with CADASIL is reported ( 95 ). The few described cases of IS caused by spontaneous carotid dissection also fall into the TOAST etiopathogenetic category of “other determined etiology,” which collects data on the known rare causes of IS.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and Cerebrovascular Diseases: A Systematic Review and Perspectives for Stroke Management

et al. 2020

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Importance: Reported cerebrovascular events in patients with COVID-19 are mainly ischemic, but hemorrhagic strokes and cerebral venous sinus thrombosis (CSVT), especially in critically ill patients, have also been described. To date, it is still not clear whether cerebrovascular manifestations are caused by direct viral action or indirect action mediated by inflammatory hyperactivation, and in some cases, the association may be casual rather than causal. Objective: To conduct a systematic review on the cerebrovascular events in COVID-19 infection. Evidence review: A comprehensive literature search on PubMed was performed including articles published from January 1, 2020, to July 23, 2020, using a suitable keyword strategy. Additional sources were added by the authors by reviewing related references. The systematic review was conducted in accordance with the PRISMA guidelines. Only articles reporting individual data on stroke mechanism and etiology, sex, age, past cardiovascular risk factors, COVID symptoms, admission NIHSS, D-dimer levels, and acute stroke treatment were selected for the review. Articles that did not report the clinical description of the cases were excluded. A descriptive statistical analysis of the data collected was performed. Finding: From a total of 1,210 articles published from January 1, 2020, to July 23, 2020, 80 articles (275 patients), which satisfied the abovementioned criteria, were included in this review. A total of 226 cases of ischemic stroke (IS), 35 cases of intracranial bleeding, and 14 cases of CVST were found. Among patients with IS, the mean age was 64.16 ±14.73 years (range 27-92 years) and 53.5% were male. The mean NIHSS score reported at the onset of stroke was 15.23 ±9.72 (range 0-40). Primary endovascular thrombectomy (EVT) was performed in 24/168 patients (14.29%), intravenous thrombolysis (IVT) was performed in 17/168 patients (10.12%), and combined IVT+EVT was performed in 11/168 patients (6.55%). According to the reported presence of large vessel occlusion (LVO) (105 patients), 31 patients (29.52%) underwent primary EVT or bridging. Acute intracranial bleeding was reported in 35 patients: 24 patients (68.57%) had intracerebral hemorrhage (ICH), 4 patients (11.43%) Fraiman et al. COVID-19 and Cerebrovascular Diseases had non-traumatic subarachnoid hemorrhage (SAH), and the remaining 7 patients (20%) had the simultaneous presence of SAH and ICH. Fourteen cases of CVST were reported in the literature (50% males), mean age 42.8 years ±15.47 (range 23-72). Treatment was reported only in nine patients; seven were treated with anticoagulant therapy; one with acetazolamide, and one underwent venous mechanical thrombectomy. Conclusion: Cerebrovascular events are relatively common findings in COVID-19 infection, and they could have a multifactorial etiology. More accurate and prospective data are needed to better understand the impact of cerebrovascular events in COVID-19 infection.

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“…In those with pre-existing intracranial stenosis, for example, hypoxemia could lead to infarction due to a mismatch between oxygen supply and demand (52). Similarly, cerebral hypoperfusion secondary to the downregulation of the RAS could increase the risk of both large vessel and SVD infarction, with a typical border-zone distribution (53,54).…”

Section: Page 13 Of 24mentioning

confidence: 99%

Stroke in COVID-19: A systematic review and meta-analysis

Nannoni

Groot

Bell

et al. 2020

International Journal of Stroke

480

496

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Background: Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, the relationship between COVID-19 and acute cerebrovascular diseases (CVD) is unclear. Aims: We aimed to characterize the incidence, risk factors, clinical-radiological manifestations and outcome of COVID-19-associated stroke. Methods: Three medical databases were systematically reviewed for published articles on acute CVD in COVID-19 (December 2019-September 2020). The review protocol was previously registered (PROSPERO ID=CRD42020185476). Data were extracted from articles reporting ï³5 stroke cases in COVID-19. We complied with the PRISMA guidelines, and used the NewcastleâOttawa Scale to assess data quality. Data were pooled using a random-effects model. Summary of review: Of 2,277 initially identified articles, 61 (2.7%) were entered in the meta-analysis. Out of 108,571 patients with COVID-19, acute CVD occurred in 1.4% (95%CI: 1.0-1.9). The most common manifestation was acute ischemic stroke (87.4%); intracerebral haemorrhage was less common (11.6%). Patients with COVID-19 developing acute CVD, compared to those who did not, were older (pooled median difference=4.8 years; 95%CI:1.7-22.4), more likely to have hypertension (OR=7.35; 95%CI:1.94-27.87), diabetes mellitus (OR=5.56; 95%CI:3.34-9.24), coronary artery disease (OR=3.12; 95%CI:1.61-6.02), and severe infection (OR=5.10; 95%CI:2.72-9.54). Compared to individuals who experienced a stroke without the infection, patients with COVID-19 and stroke were younger (pooled median difference=-6.0 years; 95%CI:-12.3 to -1.4), had higher NIHSS (pooled median difference=5; 95%CI:3-9), higher frequency of large vessel occlusion (OR=2.73; 95%CI:1.63-4.57), and higher in-hospital mortality rate (OR=5.21; 95% CI:3.43-7.90). Conclusions: Acute CVD is not uncommon in COVID-19, especially in those whom are severely infected and have pre-existing vascular risk factors. The pattern of large vessel occlusion and multi-territory infarcts suggest that cerebral thrombosis and/or thromboembolism could be possible causative pathways for the disease.

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Multiple internal border zone infarcts in a patient with COVID-19 and CADASIL

Cited by 28 publications

References 10 publications

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

COVID-19 and Cerebrovascular Diseases: A Systematic Review and Perspectives for Stroke Management

Stroke in COVID-19: A systematic review and meta-analysis

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