Ischemic stroke in the debut of coronavirus infection

Abstract

Introduction. The risk of ischemic stroke (IS) on the background of COVID-19 is about 5% and is associated with a more severe course of coronavirus infection (CVI).The aim of the study was to identify risk factors and clinical features of IS in a debut of CVI in neurological inpatients.Materials and methods. A prospective analysis of the neurological status, clinical, biochemical parameters, ultrasound examination of brachiocephalic vessels, computed tomography (CT) of the brain and the lungs was performed in 15 patients in the acute period of IS with a later detected PCR SARS-Cov-2.Results. The average age of patients is 70.3±7 years. Risk factors for IS in the debut of CVI: stenosis of 30-50% of the internal carotid artery (ICA), arterial hypertension in 100%; dyslipidemia in 86.7%; type 2 diabetes mellitus in 46.7%; coronary heart disease in a third of cases. Lung damage according to CT did not exceed 50%. There is no clear correlation between IS severity, its localization and degree of respiratory failure. The localization of IS corresponded to the side of ICA stenosis. The young patient had signs of antiphospholipid syndrome, extravasal compression of both vertebral arteries, hypoplasia of the posterior connective artery corresponding to the focus of extensive infarction in the middle cerebral artery basin.Discussion. A feature of the debut of CVI in the acute period of IS was the absence of subfebrility in the presence of increased CRP, thrombocytopenia, hyperfibrinogenemia, and a more than 3-fold increase in D-dimer, indicating early activation of platelet-vascular hemostas. The fact of the development of IS according to the side of the stenotic vessel is explained by the manifestation of latent organic pathology under the influence of CVI, thanks to the affinity of SARS-CoV-2 for the ACE2 receptors present in the vascular endothelium.Conclusion. In connection with the present epidemiological situation, the fact of the onset of IS in CVI without hyperthermia suggests an early PCR test with subsequent adequate treatment of CVI in a specialized institution together with neurologists.