Abstract
Most patients with COVID-19 present with constitutional and respiratory symptoms and some with atypical gastrointestinal, cardiovascular, or neurological manifestations. Recent studies suggest that there are neurologic manifestations of COVID-19, including acute cerebrovascular disease (CVD). The aim of this study is to find out any evidence of COVID-19 related stroke. Radiologic studies of the patients admitted to the emergency department (ED) of our center from March 11 Th to June 10 Th 2020, with acute stroke symptoms and of whom the acute cerebrovascular disease is confirmed by Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) are searched retrospectively. CT Angiography (CTA) and MR Angiography (MRA) studies obtained for stroke management, searched for acute thromboembolism. We noticed some radiologic evidence of acute cerebrovascular disease in 56 patients of 528 patients admitted with immediate neurological symptoms. 11 (19.64 %) of these patients who were not diagnosed before, proved to be simultaneous COVID-19 infection with laboratory tests and/or thorax CT. It was noteworthy that these 11 patients presented with an acute cerebrovascular event supported by neurological and radiological findings instead of the well-known constitutional or respiratory symptoms of COVID 19 infection. 45 (80.35 %) patients were negative for COVID-19 infection. CT /or MR Angiography demonstrated carotid or intracranial major arterial thromboembolism in 5 (11.1 %) of the non-COVID-19 patients and 5 (45.4 %) of the simultaneous COVID-19 disease diagnosed ones. COVID19 positive 5 patients presented with acute internal carotid artery (ICA) or major ICA branch thrombosis at the first stage of COVID-19 infection, rather than a complication of the serious lung disease or a component of multiorgan disfunction related COVID-19. Acute cerebrovascular disease symptoms bringing patients to the ED instead of the respiratory symptoms, aroused high suspicion of the direct neuropathy and early coagulopathy effect of the virus. COVID- 19 disease, itself thought to be a great risk factor for stroke alone. Even in initial cases and in cases where COVID-19 infection do not show a severe and fatal course, stimulation in the coagulation cascade in the early stages, increased the risk of acute stroke.
Highlights
Corona Virus Disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a worldwide pandemic since the first reports identified in December 2019 Wuhan, Hubei Province, China
From March 11 th to June 10 th 2020, 526 patients admitted with symptoms suspected for stroke and 56 of them diagnosed as acute cerebrovascular disease proven with cerebral Magnetic Resonance Imaging (MRI) or Computed Tomography (CT)
Focusing on these COVID-19 infected 11 patients, Polymerase Chain Reaction test (PCR) from nasal swap results were positive for 8, viral antibody IgM was positive in blood analysis for 1, IgG positive for 1 and one patient was negative for PCR but CT imaging and clinical manifestation were significant for the coronavirus infection
Summary
Corona Virus Disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a worldwide pandemic since the first reports identified in December 2019 Wuhan, Hubei Province, China. Symptoms of SARS-Cov infection range from asymptomatic disease to life-threatening acute respiratory distress syndrome (ARDS), severe pneumonia, acute kidney injury, myocarditis, multi-organ failure and death (Huang et al, 2020). Evidence of cerebrovascular complications associated with SARSCoV-2 is limited, but previous reports from the SARS epidemic in Asia in 2003 suggested a higher incidence of thromboembolic complications, including stroke (Umapathi et al, 2004). The aim of our study is to answer questions 1) Is SARSCov a neuropathic virus same like the previous coronaviruses caused SARS and MERS epidemic? The aim of our study is to answer questions 1) Is SARSCov a neuropathic virus same like the previous coronaviruses caused SARS and MERS epidemic? 2) Can SARS-Cov cause direct coagulopathy effect on CNS vessels without serious lung disease and multiorgan dysfunction?
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