Neurovascular Complications in COVID-19 Infection: Case Series

Abstract

We present a series of 10 hospitalized patients with confirmed coronavirus 2019 infections who developed severe neurovascular complications and discuss the possible reasons for these findings and their relationship to the novel Severe Acute Respiratory Syndrome coronavirus 2 infection. ABBREVIATIONS: ACE2 ¼ angiotensin-converting enzyme 2; COVID-19 ¼ coronavirus 2019; CRP ¼ C-reactive protein; CSS ¼ cytokine storm syndrome; ICU ¼ intensive care unit; LDH ¼ lactate dehydrogenase; PCR ¼ polymerase chain reaction; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2 C oronavirus disease 2019 (COVID-19) is a predominantly acute respiratory disease caused by the novel Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). 1 In addition to progressive atypical respiratory system distress, other organ systems including the CNS may be affected in part due to the marked affinity of the virus for the angiotensin-converting enzyme 2 (ACE2) receptors. 2,3 Furthermore, a subgroup of patients with severe COVID-19 develop cytokine storm syndrome (CSS), characterized by hyperinflammation due to rapid accumulation of T-cells and macrophages, resulting in the release of massive levels of cytokines into the bloodstream to eliminate the offending pathogen, causing numerous clinical manifestations including atypical respiratory system distress and fever, progressing to widespread multiorgan dysfunction. 4-7 An increasingly recognized feature of COVID-19 infection is a thromboembolic diathesis, often resulting in brain ischemia, even in young patients despite anticoagulation/antiplatelet treatment. The comorbidity of pneumonia and thromboembolic complications in patients with COVID-19 may be explained, in part, by a causal relationship of severe inflammation and infection as precipitating factors. 6-8 Here, we present the neurovascular complications in 10 hospitalized patients with COVID-19 infection at our institutions. Available neuroimaging studies including head CT, head and neck CTA, and brain MR imaging were reviewed. Case Reports

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

“…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.…”

“…19 Articles [39], [57], [58], [60], [63], [75] [86]), [92], [98], [99], [100], [101], [106], [107], [108], [109], [110], [111], [112 [101], [102], [114], [115], [116], [117], [118], [192] Dixon L et al [149] reported ANE in a 59 Y/O F with history of aplastic anemia who died despite steroid therapy.…”

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

“…Acute intracranial bleeding was reported in 35 patients with COVID-19 in the literature ( Table 2, Supplementary Table 2): 24 patients (68.57%) had intracerebral hemorrhage (ICH), 4 patients (11.43%) had non-traumatic subarachnoid hemorrhage (SAH), and the remaining 7 patients (20%) had the simultaneous presence of SAH and ICH. The mean age of the 35 patients with intracranial bleedings was 59.89 ± 11.91 years and 67.4% were males (16,25,28,64,71,73,(107)(108)(109)(110)(111)(112)(113)(114)(115)(116)(117)(118)(119)(120)(121). Two of the 11 patients with non-traumatic SAH (regardless of the presence of ICH) were found to have a ruptured dissecting aneurysm (one in the posterior inferior cerebellar artery; one in the pericallosal artery).…”

Retrospective Observational Study of Brain MRI Findings in Patients with Acute SARS-CoV-2 Infection and Neurologic Manifestations

“…It is not yet known whether this knowledge applies to the new SARS-CoV-2. So I n P r e s s far, several imaging findings have been described in the setting of COVID-19, but the relationship with SARS-CoV-2 remains unclear (8)(9)(10)(11)(12)(13)(14).…”