Case Reports in Neurology (Jun 2020)

Cerebrovascular Disease in Patients with COVID-19: A Review of the Literature and Case Series

  • Sujan T. Reddy,
  • Tanu Garg,
  • Chintan Shah,
  • Fábio A. Nascimento,
  • Rajeel Imran,
  • Peter Kan,
  • Ritvij Bowry,
  • Nicole Gonzales,
  • Andrew Barreto,
  • Abhay Kumar,
  • John Volpi,
  • Vivek Misra,
  • David Chiu,
  • Rajan Gadhia,
  • Sean I. Savitz

DOI
https://doi.org/10.1159/000508958
Journal volume & issue
Vol. 12, no. 2
pp. 199 – 209

Abstract

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COVID-19 has been associated with a hypercoagulable state causing cardiovascular and neurovascular complications. To further characterize cerebrovascular disease (CVD) in COVID-19, we review the current literature of published cases and additionally report the clinical presentation, laboratory and diagnostic testing results of 12 cases with COVID-19 infection and concurrent CVD from two academic medical centers in Houston, TX, USA, between March 1 and May 10, 2020. To date, there are 12 case studies reporting 47 cases of CVD in COVID-19. However, only 4 small case series have described the clinical and laboratory findings in patients with COVID-19 and concurrent stroke. Viral neurotropism, endothelial dysfunction, coagulopathy and inflammation are plausible proposed mechanisms of CVD in COVID-19 patients. In our case series of 12 patients, 10 patients had an ischemic stroke, of which 1 suffered hemorrhagic transformation and two had intracerebral hemorrhage. Etiology was determined to be embolic without a clear cause identified in 6 ischemic stroke patients, while the remaining had an identifiable source of stroke. The majority of the patients had elevated inflammatory markers such as D-dimer and interleukin-6. In patients with embolic stroke of unclear etiology, COVID-19 may have played a direct or indirect role in the processes that eventually led to the strokes while in the remaining cases, it is unclear if infection contributed partially or was an incidental finding.

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