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Stroke in patients with SARS-CoV-2 infection: case series.
J Neurol. 2020 Aug; 267(8):2185-2192.JN

Abstract

BACKGROUND

Italy is one of the most affected countries by the coronavirus disease 2019 (COVID-19). The responsible pathogen is named severe acute respiratory syndrome coronavirus (SARS-CoV-2). The clinical spectrum ranges from asymptomatic infection to severe pneumonia, leading to intensive care unit admission. Evidence of cerebrovascular complications associated with SARS-CoV-2 is limited. We herein report six patients who developed acute stroke during COVID-19 infection.

METHODS

A retrospective case series of patients diagnosed with COVID-19 using reverse-transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs, who developed clinical and neuroimaging evidence of acute stroke during SARS-CoV-2 infection.

RESULTS

Six patients were identified (5 men); median age was 69 years (range 57-82). Stroke subtypes were ischemic (4, 67%) and hemorrhagic (2, 33%). All patients but one had pre-existing vascular risk factors. One patient developed encephalopathy prior to stroke, characterized by focal seizures and behavioral abnormalities. COVID-19-related pneumonia was severe (i.e., requiring critical care support) in 5/6 cases (83%). Liver enzyme alteration and lactate dehydrogenase (LDH) elevation were registered in all cases. Four patients (67%) manifested acute kidney failure prior to stroke. Four patients (67%) had abnormal coagulation tests. The outcome was poor in the majority of the patients: five died (83%) and the remaining one (17%) remained severely neurologically affected (mRS: 4).

CONCLUSIONS

Both ischemic and hemorrhagic stroke can complicate the course of COVI-19 infection. In our series, stroke developed mostly in patients with severe pneumonia and multiorgan failure, liver enzymes and LDH were markedly increased in all cases, and the outcome was poor.

Authors+Show Affiliations

Unit of Neuroradiology, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy. mauro.morassi@poliambulanza.it.Unit of Neuroradiology, Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy.Unit of Neuroradiology, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy.Unit of Neuroradiology, Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy.Department of Medicine (DAME), University of Udine Medical School, Udine, Italy. Department of Mathematics, Informatics and Physics (DMIF), University of Udine, Udine, Italy. Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy.Unit of Radiology, Department of Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy.

Pub Type(s)

Case Reports
Journal Article
Observational Study

Language

eng

PubMed ID

32436105

Citation

Morassi, Mauro, et al. "Stroke in Patients With SARS-CoV-2 Infection: Case Series." Journal of Neurology, vol. 267, no. 8, 2020, pp. 2185-2192.
Morassi M, Bagatto D, Cobelli M, et al. Stroke in patients with SARS-CoV-2 infection: case series. J Neurol. 2020;267(8):2185-2192.
Morassi, M., Bagatto, D., Cobelli, M., D'Agostini, S., Gigli, G. L., Bnà, C., & Vogrig, A. (2020). Stroke in patients with SARS-CoV-2 infection: case series. Journal of Neurology, 267(8), 2185-2192. https://doi.org/10.1007/s00415-020-09885-2
Morassi M, et al. Stroke in Patients With SARS-CoV-2 Infection: Case Series. J Neurol. 2020;267(8):2185-2192. PubMed PMID: 32436105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stroke in patients with SARS-CoV-2 infection: case series. AU - Morassi,Mauro, AU - Bagatto,Daniele, AU - Cobelli,Milena, AU - D'Agostini,Serena, AU - Gigli,Gian Luigi, AU - Bnà,Claudio, AU - Vogrig,Alberto, Y1 - 2020/05/20/ PY - 2020/04/09/received PY - 2020/05/04/accepted PY - 2020/05/01/revised PY - 2020/5/22/pubmed PY - 2020/7/23/medline PY - 2020/5/22/entrez KW - Brain hemorrhage KW - COVID-19 KW - Cerebrovascular disease KW - Coronavirus KW - Encephalitis KW - Neurological complications SP - 2185 EP - 2192 JF - Journal of neurology JO - J. Neurol. VL - 267 IS - 8 N2 - BACKGROUND: Italy is one of the most affected countries by the coronavirus disease 2019 (COVID-19). The responsible pathogen is named severe acute respiratory syndrome coronavirus (SARS-CoV-2). The clinical spectrum ranges from asymptomatic infection to severe pneumonia, leading to intensive care unit admission. Evidence of cerebrovascular complications associated with SARS-CoV-2 is limited. We herein report six patients who developed acute stroke during COVID-19 infection. METHODS: A retrospective case series of patients diagnosed with COVID-19 using reverse-transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs, who developed clinical and neuroimaging evidence of acute stroke during SARS-CoV-2 infection. RESULTS: Six patients were identified (5 men); median age was 69 years (range 57-82). Stroke subtypes were ischemic (4, 67%) and hemorrhagic (2, 33%). All patients but one had pre-existing vascular risk factors. One patient developed encephalopathy prior to stroke, characterized by focal seizures and behavioral abnormalities. COVID-19-related pneumonia was severe (i.e., requiring critical care support) in 5/6 cases (83%). Liver enzyme alteration and lactate dehydrogenase (LDH) elevation were registered in all cases. Four patients (67%) manifested acute kidney failure prior to stroke. Four patients (67%) had abnormal coagulation tests. The outcome was poor in the majority of the patients: five died (83%) and the remaining one (17%) remained severely neurologically affected (mRS: 4). CONCLUSIONS: Both ischemic and hemorrhagic stroke can complicate the course of COVI-19 infection. In our series, stroke developed mostly in patients with severe pneumonia and multiorgan failure, liver enzymes and LDH were markedly increased in all cases, and the outcome was poor. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/32436105/Stroke_in_patients_with_SARS_CoV_2_infection:_case_series_ L2 - https://dx.doi.org/10.1007/s00415-020-09885-2 DB - PRIME DP - Unbound Medicine ER -