Abstract
BackgroundThe coronavirus disease 2019 is associated with neurological manifestations including stroke.ObjectivesWe present a case series of coronavirus disease 2019 patients from two institutions with acute cerebrovascular pathologies. In addition, we present a pooled analysis of published data on large vessel occlusion in the setting of coronavirus disease 2019 and a concise summary of the pathophysiology of acute cerebrovascular disease in the setting of coronavirus disease 2019.MethodsA retrospective study across two institutions was conducted between 20 March 2020 and 20 May 2020, for patients developing acute cerebrovascular disease and diagnosed with coronavirus disease 2019. We performed a literature review using the PubMed search engine.ResultsThe total sample size was 22 patients. The mean age was 59.5 years, and 12 patients were female. The cerebrovascular pathologies were 17 cases of acute ischemic stroke, 3 cases of aneurysm rupture, and 2 cases of sinus thrombosis. Of the stroke and sinus thrombosis patients, the mean National Institute of Health Stroke Scale was 13.8 ± 8.0, and 16 (84.2%) patients underwent a mechanical thrombectomy procedure. A favorable thrombolysis in cerebral infarction score was achieved in all patients. Of the 16 patients that underwent a mechanical thrombectomy, the mortality incidence was five (31.3%). Of all patients (22), three (13.6%) patients developed hemorrhagic conversion requiring decompressive surgery. Eleven (50%) patients had a poor functional status (modified Rankin Score 3–6) at discharge, and the total mortality incidence was eight (36.4%).ConclusionsDespite timely intervention and favorable reperfusion, the mortality rate in coronavirus disease 2019 patients with large vessel occlusion was high in our series and in the pooled analysis. Notable features were younger age group, involvement of both the arterial and venous vasculature, multivessel involvement, and complicated procedures due to the clot consistency and burden.
Highlights
In six months, the number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases exceeded six million, with more than 360,000 deaths
Despite timely intervention and favorable reperfusion, the mortality rate in coronavirus disease 2019 patients with large vessel occlusion was high in our series and in the pooled analysis
We present a case series of COVID-19 patients from two different health systems presenting with acute cerebrovascular pathologies
Summary
The number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases exceeded six million, with more than 360,000 deaths. The World Health Organization named the disease the coronavirus disease 2019 (COVID-19) and declared it a pandemic on 11 March 2020.1 the lung is the primary affected organ, the virus is neurovirulent and International Journal of Stroke, 15(7). In the current pandemic situation, a better understanding of the pathophysiological mechanisms associated with COVID-19 and characterization of cerebrovascular pathologies and outcomes is critical to estimate the risk and to guide decision making. We present a case series of COVID-19 patients from two different health systems presenting with acute cerebrovascular pathologies. We reviewed the literature to present a comprehensive summary of the SARS-CoV-2-induced factors that are associated with acute cerebrovascular pathologies. The coronavirus disease 2019 is associated with neurological manifestations including stroke
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