Ischemic Stroke as a Clinical Form and Pathogenetic Model in the Structure of Сentral Nervous System Lesions in COVID-19

Abstract

Models of pathogenetic effects of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the new coronavirus infection 2019 (COVID-19) on the brain indicate the possibility of both direct and indirect damage. Objective of the research. to study the features of the course of ischemic stroke in patients with COVID-19 disease. Methods. A retrospective analysis of 5 cases of acute ischaemic stroke in patients with COVID 19 who underwent inpatient treatment in march – April 2020 in one of the multi-specialty hospitals in Saint Petersburg, which was re-designated to receive patients with COVID-19 infection and has a primary vascular department. Results. Among 5 patients COVID-19 (3 men, 2 women; average age 76.8Ѓ}12.0 years), 3 registered in-hospital ischemic stroke (IHS), 2 patients were hospitalized with suspected cerebral stroke by ambulance. In vivo, COVID-19 was diagnosed in 3 patients; in 2 cases, the SARS-COV 2 virus was detected in the sectional material. All patients had high comorbidity: a history of stroke and/or myocardial infarction; 3 patients had diabetes mellitus; 2 had atrial fibrillation. Patients with IHS at the time of stroke development received secondary prevention of vascular events. The severity of ischemic stroke was 21.4Ѓ}4.3 on the NIHSS scale. According to the TOAST classification, the stroke was atherothrombotic (n=2), cardioembolic (n=1) and unspecified subtypes (n=2). Adverse outcome was registered in all cases on 5–11 day of stroke development (the average life expectancy after a stroke = 7,4 days). Conclusion. Experience in treating patients with COVID-19 indicates the need for monitoring the coagulation system and active prevention of thrombosis. Providing care to patients with ischemic stroke on the background of COVID-19 is associated with additional organizational difficulties associated with the need to comply with strict anti-epidemic measures, which affect the intra- hospital logistics and quality of care.