Vessel wall magnetic resonance imaging in COVID‐19‐associated cryptogenic ischemic stroke

Abstract

Background and purpose Acute ischemic stroke (AIS) is a common complication of coronavirus disease 2019 (COVID‐19), but the underlying biological mechanisms remain unclear. We aimed to describe the prevalence of vessel wall alterations in patients with cryptogenic stroke through vessel wall magnetic resonance imaging (vwMRI). Methods All consecutive patients admitted for AIS and COVID‐19 to a single neuro‐COVID unit from 10 November to 31 December 2020 were prospectively evaluated and underwent a complete etiologic workup for AIS. In patients with cryptogenic stroke, the diagnostic workup was completed with vwMRI study. Results After the exclusion of four patients ineligible for MRI, a total of 10 patients were included (median age = 78 years, 50% males), of whom four (40%) had a cryptogenic stroke. vwMRI showed vascular changes consistent with inflammation of intracranial artery walls in three subjects (75%). Two patients had focal and one multifocal involvement. Conclusions vwMRI detected signs of vascular inflammation in the majority of patients with cryptogenic AIS, leading to an etiologic definition with potential therapeutical implications. Our findings are best interpreted as hypothesis‐generating, suggesting the possibility of expanding the diagnostic workup of cryptogenic stroke with vessel wall imaging.

International Prevalence and Mechanisms of SARS-CoV-2 in Childhood Arterial Ischemic Stroke During the COVID-19 Pandemic

“…In 2 reported cases of SARS-CoV-2-related stroke in children, 1 with arteritis (also included in this cohort) and 1 with focal cerebral arteriopathy, vessel wall imaging demonstrated enhancement, which further supports an inflammatory mechanism of SARS-CoV-2-related arteriopathies, 8 , 10 and this mirrors findings in adults. 24 The hemorrhagic transformation present in 1 child with arteritis may reflect endotheliitis-related vessel fragility. Furthermore, patients with MIS-C present with a different inflammatory milieu than those with COVID-19, 25 , 26 and MIS-C may also contribute to cases of arteriopathy.…”

Vessel wall imaging in COVID-19 associated carotid atherothrombosis and stroke: a case report and literature review

“…On the contrary, Guggenberger et al 15 argued that the reported VWI findings by Uginet et al were also possibly due to enhancement associated with intracranial vasa vasorum, developing with advancing age, seen in their own cohort with no clinical or laboratory features of vasculitis. Another study by Mazzacane et al 16 reported concentric vessel wall thickening and enhancement of the involved arterial territories, with associated stenosis and/or occlusion on MRA and cerebral angiography, of patients with COVID-19 deemed to have cryptogenic stroke. We feel that VWI findings that are seen in patients with COVID-19 associated neurological syndromes do not definitively confirm causality, nor do they exclude in total the contributory role of COVID-19 infection in the pathophysiology.…”

Imaging features and ultraearly hematoma growth in intracerebral hemorrhage associated with COVID-19

“…First, intracranial vessel imaging was not standardized and performed in many included patients. Signs of intracranial vessel wall inflammation have been recently described in COV19 + patients with neurological involvement and we were not able to systematically investigate this potential determinant of intracranial bleeding [ 12 , 13 ]. Second, selection bias in favor of less severely affected patients may have occurred, as all the included subjects were not primarily admitted to intensive care or neurosurgery units.…”