CLINICAL AND LABORATORY CHARACTERISTICS OF PATIENTS WITH ACUTE ISCHEMIC STROKE AND COVID-19: CASE SERIES AND OF LITERATURE REVIEW
Keywords:
acute ischemic stroke, clinical and laboratory characteristics, COVID-19 infection, COVID-19 pneumoniaAbstract
Introduction: COVID-19 is closely linked to coagulopathy and consequently thromboembolism, thus increasing the probability for development of ischemic strokes.
Aim: The purpose of our study was to evaluate the clinical, laboratory and neuroimaging characteristics as well as outcome in patients with COVID-19 who developed acute ischemic stroke (AIS), hospitalized at the COVID Center at the University Clinic for Neurology in Skopje, N. Macedonia during the period of November 2020 - March 2021.
Material and methods: We conducted a retrospective analysis of ten patients with acute ischemic stroke, out of 566 COVID-19 patients hospitalized at the COVID Center at the University Clinic for Neurology in Skopje, N. Macedonia. during the period of November 2020 - March 2021 Demographic characteristics, level of consciousness, stroke type, region and volume, presence of hemorrhagic transformation and mass effect, comorbidities, level of D-dimer and inflammatory markers, presence of pneumonia and outcome of the patients were analyzed.
Results: Majority of patients developed ischemic strokes secondary to large-vessel occlusion in the anterior circulation and only one patient had posterior circulation stroke. Three patients developed massive stroke with hemorrhagic transformation and mass effect. Seven patients developed COVID-19 associated pneumonia.
Conclusion: Acute ischemic stroke in patients with COVID-19 is more likely to occur in elderly patients with cardiovascular comorbidities. Aging, comorbidities, impaired level of consciousness and increased level of D-dimer and CRP on admission along with COVID-19 pneumonia contribute to the fatal outcome.
References
Salamanna F, Maglio M, Landini MP, Fini M. Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2. Front Med (Lausanne) 2020; 7: 594495. Published 2020 Dec 3. doi: 10.3389/fmed.2020.594495.
Flores G. SARS-COV-2 (COVID-19) has neurotropic and neuroinvasive properties. Int J Clin Pract 2021; 75: e13708. https://doi.org/10.1111/ijcp.13708.
Hayat U, Ahmed S, Hussain MA, Hameed N. Encephalopathy as the Presenting Symptom of COVID-19. Kans J Med 2020; 13: 272-274. Published 2020 Oct 20. doi:10.17161/kjm.vol13.14766.
Zakeri A, Jadhav AP, Sullenger BA, Nimjee SM. Ischemic stroke in COVID-19-positive patients: an overview of SARS-CoV-2 and thrombotic mechanisms for the neurointerventionalist. Journal of NeuroInterventional Surgery 2021; 13: 202-206.
Das M, Penn C, Martinez T, Mayilsamy K, McGill A, Wiling A, et al. COVID-19 neurotropism and implications for therapy. Neuroimmunology and Neuroinflammation 2020. https://doi.org/10.20517/2347-8659.2020.36.
Francisco J Barrantes. Central Nervous System Targets and Routes for SARS-CoV-2: Current Views and New Hypotheses. American Chemical Society Inc. ACS Chemical Neuroscience 2020; 11(18): 2793-2803.
Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell 2020; 181(2): 271-280. e8. doi: 10.1016/j.cell.2020.02.052.
Datta PK, Liu F, Fischer T, Rappaport J, Qin X. SARS-CoV-2 pandemic and research gaps: Understanding SARS-CoV-2 interaction with the ACE2 receptor and implications for therapy. Theranostics 2020; 10(16): 7448-7464. doi:10.7150/thno.48076. Available from https://www.thno.org/v10p7448.htm.
Septyaningtrias, Dian Eurike and Susilowati, Rina. "Neurological involvement of COVID-19: from neuroinvasion and neuroimmune crosstalk to long-term consequences". Reviews in the Neurosciences 2021; 32(4): 427-442. https://doi.org/10.1515/revneuro-2020-0092.
Yang Y, Rosenberg GA. Blood-brain barrier breakdown in acute and chronic cerebrovascular disease. Stroke 2011; 42(11): 3323-3328. doi: 10.1161/STROKEAHA.110.608257.
Santana Bezerra ALM, Menezes Morgado A, Gonçalves Felix EB, Bezerra Cunha FM, Rolim Neto M, et al. Beyond The Lungs: SARS-CoV-2 Pathways to the Nervous System and Its Consequences. Arch Med Vol 2021; 13(6) : 28 ili 25???
Cao W, Zhang C, Wang H, Wu Q, Yuan Y, Chen J, et al. Ischemic Stroke: An Underestimated Complication of COVID-19. Aging Dis 2021; 12(3): 691-704. Published 2021 Jun 1. doi: 10.14336/AD.2021.0209.
Qi X, Keith KA, Huang JH. COVID-19 and stroke: A review. Brain Hemorrhages. 2021; 2(2): 76-83. doi: 10.1016/j.hest.2020.11.001.
Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V, et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost 2020; 18(7): 1738-1742. https://doi.org/10.1111/jth.14 850.
Martí-Fàbregas J, Guisado-Alonso D, Delgado-Mederos R, Martínez-Domeño A, Prats-Sánchez L, Guasch-Jiménez M, et al. Impact of COVID-19 Infection on the Outcome of Patients With Ischemic Stroke. Stroke. 2021;52(12):3908-3917. doi:10.1161/STROKEAHA.121.034883.
Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke & Vascular Neurology 2020;5: e000431. doi:10.1136/svn-2020 000431.
Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol 2020; 77(6): 683-690. doi: 10.1001/jamaneurol.2020.1127.
Zhang S, Zhang J, Wang C, Chen X, Zhao X, Jing H, et al. COVID 19 and ischemic stroke: Mechanisms of hypercoagulability (Review). Int J Mol Med. 2021; 47(3): 21. doi:10.3892/ijmm.2021.4854.
South K, McCulloch L, McColl BW, Elkind MS, Allan SM, Smith CJ. Preceding infection and risk of stroke: An old concept revived by the COVID-19 pandemic. International Journal of Stroke. 2020; 15(7): 722-732. doi: 10.1177/17474930209 43815.
Yaghi S, Ishida K, Torres J, Mac Grory B, Raz E, Humbert K, et al. SARS-CoV-2 and Stroke in a New York Healthcare System. Stroke 2020; 51(7): 2002-2011. https://doi.org/10.1161/STROKEAHA.120.030335.
Fulton RB, Varga SM. Effects of aging on the adaptive immune response to respiratory virus infections. Aging health 2009; 5(6): 775. doi:10.2217/ahe.09.69.
Spence JD, de Freitas GR, Pettigrew LC, Ay H, Liebeskind D, Kase CS, et al. Mechanisms of Stroke in COVID-19. Cerebrovasc Dis 2020; 49(4): 451-458. doi:10.1159/000509581.
Siow I, Lee KS, Zhang JJY, Saffari SE, Ng A, Young B. Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence, Outcomes and Predictors. J Stroke Cerebrovasc Dis. 2021; 30(3): 105549. doi: 10.1016/j.jstrokecerebrovasdis.2020.105549.
