Acute Ischemic Stroke and COVID-19

Qureshi, Adnan I; Baskett, William I; Huang, Wei; Shyu, Daniel; Myers, Danny; Raju, Murugesan; Lobanova, Iryna; Suri, M. Fareed K.; Naqvi, S. Hasan; French, Brandi R; Siddiq, Farhan; Gomez, Camilo R.

doi:10.1161/strokeaha.120.031786

Cited by 239 publications

(139 citation statements)

References 28 publications

(35 reference statements)

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“…This hyperinflammatory state can lead to a cytokine storm extending to the nervous system, with possible acute necrotizing encephalitis (ANE) [ 164 ]. Stroke can also occur secondary to altered coagulative status in COVID-19 [ 165 – 168 ].…”

Section: Sars-cov-2 Infectionmentioning

confidence: 99%

Infectious disease-associated encephalopathies

et al. 2021

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Infectious diseases may affect brain function and cause encephalopathy even when the pathogen does not directly infect the central nervous system, known as infectious disease-associated encephalopathy. The systemic inflammatory process may result in neuroinflammation, with glial cell activation and increased levels of cytokines, reduced neurotrophic factors, blood–brain barrier dysfunction, neurotransmitter metabolism imbalances, and neurotoxicity, and behavioral and cognitive impairments often occur in the late course. Even though infectious disease-associated encephalopathies may cause devastating neurologic and cognitive deficits, the concept of infectious disease-associated encephalopathies is still under-investigated; knowledge of the underlying mechanisms, which may be distinct from those of encephalopathies of non-infectious cause, is still limited. In this review, we focus on the pathophysiology of encephalopathies associated with peripheral (sepsis, malaria, influenza, and COVID-19), emerging therapeutic strategies, and the role of neuroinflammation. Graphic abstract

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Section: Sars-cov-2 Infectionmentioning

confidence: 99%

Infectious disease-associated encephalopathies

et al. 2021

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“…However, with regards to ischemic stroke, epidemiological data do not show a higher incidence among COVID-19 patients. (17,41) Thus, secondary ICH due to hemorrhagic transformation/parenchymal hematoma is likely to be dependent on the use of antithrombotic agents in stroke management rather than direct effects of SARS-CoV2. Sinus venous thrombosis is infrequently reported in the context of COVID-19 but may be driven by its hypercoagulable features.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and intracranial hemorrhage: a multicenter case series, systematic review and pooled analysis

Schmidbauer

Ferse

Salih

et al. 2021

Preprint

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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) profoundly impacts on hemostasis and microvasculature. Correspondingly, antithrombotic therapy is frequently used for prophylaxis or treatment of thromboembolic complications as well as in the context of extracorporeal membrane oxygenation (ECMO). However, reports of intracranial hemorrhage (ICH) associated with Coronavirus disease 2019 (COVID-19) have also emerged. In the light of the dilemma between thromboembolic and hemorrhagic complications, we sought to systematically investigate incidence, mortality, radiological subtypes and clinical characteristics of ICH in COVID-19 patients.Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review of literature by screening the PubMed database and included patients diagnosed with COVID-19 and concomitant ICH. Furthermore, we performed a pooled analysis including a prospectively collected cohort of critically ill COVID-19 patients with ICH as part of the PANDEMIC registry (Pooled Analysis of Neurologic Disorders Manifesting in Intensive care of COVID-19).Results: Our literature review revealed a total of 217 citations. After selection process, 79 studies and a total of 477 patients were included. Median age was 58.8 years (95% CI 54.8 years-62.9 years; I2 = 85,6%). 23.3% patients experienced critical stage of COVID-19 (95% CI 8.9% − 61.2%, I2 = 53.8%). 62.7% patients were on anticoagulation (95% CI 38.2% − 103.0%, I2 = 82,6%), and 27.5% patients received ECMO (95% CI 5.8% − 130.2%, I2 = 92.7%). Microbleeds (51.1%, 95% CI 31.1% − 84.2%, I2 = 85.1%), subarachnoid hemorrhage (SAH) (26.6%, 95% CI 16.8% − 42.0%, I2 = 61.2%) and intraparenchymal hemorrhage (IPH) (33.7%, 95% CI 23.3% − 48.8%, I2 = 63.7%) were most frequently documented as ICH subtypes. Incidence was at 0.85% (95% CI 0.36%-1.99%; I2 = 97.5%) and mortality at 52.18% (95% CI 40.40%-67.39%; I2 = 51.7%), respectively.Conclusion: ICH in COVID-19 patients is rare, but has a very poor prognosis. Different subtypes of ICH seen in COVID-19 support the assumption of heterogenous and multifactorial pathomechanisms contributing to ICH in COVID-19. Further data and pathophysiological insights are warranted to resolve the conflict between thromboembolic and hemorrhagic complications in the future.

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“…In einer umfangreichen retrospektiven Analyse von Qureshi et al. [ 21 ] wurden nun Risikofaktoren, Komorbiditäten, Behandlungsstrategien und -ergebnisse von Patienten mit einem ischämischen Schlaganfall aus einer Kohorte von einerseits klinischen Verdachtsfällen ohne bestätigenden Nachweis und andererseits laborchemisch bestätigten Erkrankungen durch SARS-CoV‑2 („coronavirus disease 2019“, COVID-19) anhand von ICD-Codes untersucht. Zugrunde lag eine Datenbank („Cerner De-Identified COVID-19 Dataset“ als Teil der „Cerner Real-World Data“), in der Informationen von 27.676 Patienten vorlagen, eingepflegt von 54 US-amerikanischen Zentren in den Jahren 2019 und 2020.…”

Section: Covid-19 Und Schlaganfallunclassified

“…In einer bemerkenswert großen Stichprobe fanden Qureshi et al. [ 21 ] keinen Unterschied in der Häufigkeit von Schlaganfällen zwischen Patienten mit COVID-19 und denen mit letztlich nichtbestätigter Erkrankung. In der Gruppe der Patienten mit COVID-19 war das Auftreten eines Schlaganfalls mit den üblichen vaskulären Risikofaktoren, aber auch mit einem 2‑fach erhöhten Risiko für ein Versterben innerhalb des Krankenhausaufenthalts und eine Entlassung in das nichthäusliche Umfeld assoziiert.…”

Section: Covid-19 Und Schlaganfallunclassified

“…Die in der Studie von Qureshi et al. [ 21 ] im Zusammenhang mit COVID-19 und einem Schlaganfall vermehrt wahrgenommenen Organdysfunktionen könnten als Begründung für das relevant schlechtere funktionelle Behandlungsergebnis und die erhöhte Sterblichkeit in dieser Risikogruppe herangezogen werden. Bemerkenswert ist ferner die mit einem Prozent sehr geringe Rate an erfolgter Akuttherapie, für die als Gründe verkomplizierte Abläufe bei der mechanischen Thrombektomie sowie eine relevant verzögerte Krankenhauseinweisung oder eine Verzögerung in der eigeninitiierten Vorstellung unter Pandemiebedingungen naheliegend wären.…”

Section: Covid-19 Und Schlaganfallunclassified

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