Cerebral nervous system vasculitis in a Covid-19 patient with pneumonia

Vaschetto, Rosanna; Cena, Tiziana; Sainaghi, Pier Paolo; Meneghetti, Grazia; Bazzano, Simona; Vecchio, Domizia; Pirisi, Mario; Brustia, Diego; Barini, Michela; Cammarota, Gianmaria; Castello, Luigi Mario; Corte, Francesco Della

doi:10.1016/j.jocn.2020.07.032

Cited by 44 publications

(54 citation statements)

References 8 publications

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“…Unifocal and multifocal lesions with features of CNS vasculitis have been reported in patients with severe COVID-19; however, histological studies substantiating the nature of the pathology are needed. 77 The co-occurrence of diffuse cutaneous lesions and extensive ischaemic lesions in the deep brain on MRI, without any discernible vascular source, have been proposed to suggest a cerebral vasculitis centred on the endothelium. 78 However, pathological reports favouring thromboembolism over vasculitis are emerging.…”

Section: Brain Involvement In Covid-19: Vasculitis Mimics Rather Thanmentioning

confidence: 99%

COVID-19 vasculitis and novel vasculitis mimics

McGonagle

Bridgewood

Ramanan

et al. 2021

The Lancet Rheumatology

144

124

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Section: Brain Involvement In Covid-19: Vasculitis Mimics Rather Thanmentioning

confidence: 99%

COVID-19 vasculitis and novel vasculitis mimics

McGonagle

Bridgewood

Ramanan

et al. 2021

The Lancet Rheumatology

144

124

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“…Another mechanism of cerebrovascular damage that has been postulated more recently, similar to what has been documented histopathologically in other organs, is through an endothelitis process ( 14 , 15 ), which would account largely for the microangiopathic neuroimaging pattern described recently in a case series ( 16 – 18 ) and case report ( 19 ). The final cerebrovascular damage would have a neuroimaging pattern suggestive of a vasculitic process affecting the central nervous system ( 20 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and Cerebrovascular Diseases: A Systematic Review and Perspectives for Stroke Management

et al. 2020

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Importance: Reported cerebrovascular events in patients with COVID-19 are mainly ischemic, but hemorrhagic strokes and cerebral venous sinus thrombosis (CSVT), especially in critically ill patients, have also been described. To date, it is still not clear whether cerebrovascular manifestations are caused by direct viral action or indirect action mediated by inflammatory hyperactivation, and in some cases, the association may be casual rather than causal. Objective: To conduct a systematic review on the cerebrovascular events in COVID-19 infection. Evidence review: A comprehensive literature search on PubMed was performed including articles published from January 1, 2020, to July 23, 2020, using a suitable keyword strategy. Additional sources were added by the authors by reviewing related references. The systematic review was conducted in accordance with the PRISMA guidelines. Only articles reporting individual data on stroke mechanism and etiology, sex, age, past cardiovascular risk factors, COVID symptoms, admission NIHSS, D-dimer levels, and acute stroke treatment were selected for the review. Articles that did not report the clinical description of the cases were excluded. A descriptive statistical analysis of the data collected was performed. Finding: From a total of 1,210 articles published from January 1, 2020, to July 23, 2020, 80 articles (275 patients), which satisfied the abovementioned criteria, were included in this review. A total of 226 cases of ischemic stroke (IS), 35 cases of intracranial bleeding, and 14 cases of CVST were found. Among patients with IS, the mean age was 64.16 ±14.73 years (range 27-92 years) and 53.5% were male. The mean NIHSS score reported at the onset of stroke was 15.23 ±9.72 (range 0-40). Primary endovascular thrombectomy (EVT) was performed in 24/168 patients (14.29%), intravenous thrombolysis (IVT) was performed in 17/168 patients (10.12%), and combined IVT+EVT was performed in 11/168 patients (6.55%). According to the reported presence of large vessel occlusion (LVO) (105 patients), 31 patients (29.52%) underwent primary EVT or bridging. Acute intracranial bleeding was reported in 35 patients: 24 patients (68.57%) had intracerebral hemorrhage (ICH), 4 patients (11.43%) Fraiman et al. COVID-19 and Cerebrovascular Diseases had non-traumatic subarachnoid hemorrhage (SAH), and the remaining 7 patients (20%) had the simultaneous presence of SAH and ICH. Fourteen cases of CVST were reported in the literature (50% males), mean age 42.8 years ±15.47 (range 23-72). Treatment was reported only in nine patients; seven were treated with anticoagulant therapy; one with acetazolamide, and one underwent venous mechanical thrombectomy. Conclusion: Cerebrovascular events are relatively common findings in COVID-19 infection, and they could have a multifactorial etiology. More accurate and prospective data are needed to better understand the impact of cerebrovascular events in COVID-19 infection.

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“…SARS-CoV-1 infections are associated with systemic vasculitis, featuring leukocyte infiltration and endothelial cell proliferation, swelling, and apoptosis ( 77 ). Similarly, there are reports of patients with SARS-CoV-2 presenting with cerebral vasculitis and vasculopathy with micro- and macrohemorrhage ( 48 , 78 – 80 ).…”

Section: Factors Associated With Stroke In Patients Infected With Sars-cov-2mentioning

confidence: 80%

Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology

Neshin

Shahjouei

Koza

et al. 2021

Front. Cardiovasc. Med.

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Since the early days of the pandemic, there have been several reports of cerebrovascular complications during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Numerous studies proposed a role for SARS-CoV-2 in igniting stroke. In this review, we focused on the pathoetiology of stroke among the infected patients. We pictured the results of the SARS-CoV-2 invasion to the central nervous system (CNS) via neuronal and hematogenous routes, in addition to viral infection in peripheral tissues with extensive crosstalk with the CNS. SARS-CoV-2 infection results in pro-inflammatory cytokine and chemokine release and activation of the immune system, COVID-19-associated coagulopathy, endotheliitis and vasculitis, hypoxia, imbalance in the renin-angiotensin system, and cardiovascular complications that all may lead to the incidence of stroke. Critically ill patients, those with pre-existing comorbidities and patients taking certain medications, such as drugs with elevated risk for arrhythmia or thrombophilia, are more susceptible to a stroke after SARS-CoV-2 infection. By providing a pictorial narrative review, we illustrated these associations in detail to broaden the scope of our understanding of stroke in SARS-CoV-2-infected patients. We also discussed the role of antiplatelets and anticoagulants for stroke prevention and the need for a personalized approach among patients with SARS-CoV-2 infection.

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Cerebral nervous system vasculitis in a Covid-19 patient with pneumonia

Abstract: Highlights Novel coronavirus (COVID-19) directly or indirectly may affect cerebral nervous system. We described the first case of cerebral nervous system vasculitis triggered by COVID-19. Medical treatment with both immunoglobulins and steroids ameliorated both MRI and clinical symptoms.

Cited by 44 publications

References 8 publications

COVID-19 vasculitis and novel vasculitis mimics

COVID-19 vasculitis and novel vasculitis mimics

COVID-19 and Cerebrovascular Diseases: A Systematic Review and Perspectives for Stroke Management

Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology

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