Reversible cerebral vasoconstriction syndrome and dissection in the setting of COVID-19 infection

Dakay, Katarina; Kaur, Gurmeen; Gulko, Edwin; Santarelli, Justin; Bowers, Christian A.; Mayer, Stephan A.; Gandhi, Chirag D.; Al‐Mufti, Fawaz

doi:10.1016/j.jstrokecerebrovasdis.2020.105011

Cited by 58 publications

(59 citation statements)

References 9 publications

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“…Reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome may mimic primary angiitis of the CNS and have been recently described in COVID-19 patients. 40–42 IS, ICH, and convexal subarachnoid hemorrhage are common manifestations of reversible cerebral vasoconstriction syndrome. 43…”

Section: Resultsmentioning

confidence: 99%

COVID-19 and cerebrovascular diseases: a comprehensive overview

Tsivgoulis

Palaiodimou

Zand

et al. 2020

Ther Adv Neurol Disord

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Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.

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Section: Resultsmentioning

confidence: 99%

COVID-19 and cerebrovascular diseases: a comprehensive overview

Tsivgoulis

Palaiodimou

Zand

et al. 2020

Ther Adv Neurol Disord

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“…One case with bilateral and one with unilateral vertebral artery dissection were reported in two SARS‐Cov‐2‐positive female patients with a history of migraine 99,100 . The latter was also found to suffer from bilateral high frontal convexity subarachnoid hemorrhage (cSAH) on CT and evidence of RCVS in the anterior and middle cerebral circulation.…”

Section: Cerebrovascular Diseasesmentioning

confidence: 97%

“…One case with bilateral and one with unilateral vertebral artery dissection were reported in two SARS-Cov-2-positive female patients with a history of migraine. 99,100 The latter was also found to suffer from bilateral high frontal convexity subarachnoid hemorrhage (cSAH) on CT and evidence of RCVS in the anterior and middle cerebral circulation. Whether the endothelial dysfunction caused by the SARS-CoV-2 led to the vertebral artery dissection and subsequently to RCVS t caused the cSAH, or the underlying history of migraine was the crucial etiological factor with the coronavirus infection being incidental, remains speculative.…”

Section: Other Cerebrovascular Manifestationsmentioning

confidence: 99%

COVID‐19: Neuroimaging Features of a Pandemic

Ladopoulos

Zand

Shahjouei

et al. 2021

Journal of Neuroimaging

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The ongoing Coronavirus Disease 2019 (COVID-19) pandemic is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is occasionally associated with manifold diseases of the central nervous system (CNS). We sought to present the neuroimaging features of such CNS involvement. In addition, we sought to identify typical neuroimaging patterns that could indicate possible COVID-19-associated neurological manifestations. METHODS: In this systematic literature review, typical neuroimaging features of cerebrovascular diseases and inflammatory processes associated with COVID-19 were analyzed. Reports presenting individual patient data were included in further quantitative analysis with descriptive statistics. RESULTS: We identified 115 studies reporting a total of 954 COVID-19 patients with associated neurological manifestations and neuroimaging alterations. A total of 95 (82.6%) of the identified studies were single case reports or case series, whereas 660 (69.2%) of the reported cases included individual information and were thus included in descriptive statistical analysis. Ischemia with neuroimaging patterns of large vessel occlusion event was revealed in 59.9% of ischemic stroke patients, whereas 69.2% of patients with intracerebral hemorrhage exhibited bleeding in a location that was not associated with hypertension. Callosal and/or juxtacortical location was identified in 58.7% of cerebral microbleed positive images. Features of hemorrhagic necrotizing encephalitis were detected in 28.8% of patients with meningo-/encephalitis. CONCLUSIONS: Manifold CNS involvement is increasingly reported in COVID-19 patients. Typical and atypical neuroimaging features have been observed in some disease entities, so that familiarity with these imaging patterns appears reasonable and may assist clinicians in the differential diagnosis of COVID-19 CNS manifestations.

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“…Interestingly, some case reports suggest a potential correlation between COVID-19 and arterial dissection involving extra-cranial vertebral artery [ 11 , 49 ] or carotid artery [ 50 ], including patients with unremarkable medical history or cardio-vascular risk factors. In one case [ 51 ], cervical vertebral artery dissection was associated with digital subtraction angiography-confirmed reversible cerebral vasoconstriction syndrome (RCVS) involving the anterior circulation associated with bilateral frontal subarachnoid hemorrhage (SAH). Al Saiegh et al described a case of massive SAH in the posterior fossa and in the fourth ventricle due to rupture of a dissecting aneurysm of the PICA [ 43 ].…”

Section: Neuroimaging Featuresmentioning

confidence: 99%

Stroke in patients with COVID-19: Clinical and neuroimaging characteristics

Vogrig

Gigli

Bnà

et al. 2021

Neuroscience Letters

118

124

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Highlights Stroke is an infrequent, but potentially life-threatening, complication of COVID-19. Typical features include large vessel occlusion and multi-territory stroke. Atypical presentations include PRES, vasculitis, and arterial dissection. Sedation interruption may be required for neurologic evaluation of ICU patients. Older age, elevated D-dimer, LDH, and creatinine are associated with poor outcome.

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Reversible cerebral vasoconstriction syndrome and dissection in the setting of COVID-19 infection

Cited by 58 publications

References 9 publications

COVID-19 and cerebrovascular diseases: a comprehensive overview

COVID-19 and cerebrovascular diseases: a comprehensive overview

COVID‐19: Neuroimaging Features of a Pandemic

Stroke in patients with COVID-19: Clinical and neuroimaging characteristics

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