“COVID-19 and cervical artery dissection- A causative association?”

Abstract

COVID-19 is a pandemic disease which predominantly affects the respiratory system, however it also causes multi-organ dysfunction in a subset of patients. There is a growing evidence that it increases the propensity of strokes in younger patients. Besides producing a prothrombotic state, arterial dissection could be one of its many manifestations, increasing the risks of stroke. Herein, we report the first case of spontaneous bilateral vertebral artery dissection in a patient with COVID-19. 39-year female presented with spontaneous bilateral vertebral artery dissections without any instigating traumatic events and no history of connective tissue disorders. Whether this patient's vertebral artery dissections were triggered by exaggerated inflammatory response or arteriopathy secondary to COVID-19 remains speculative. Nonetheless, arterial dissection could be one of it's complications. It is important for the physicians to be aware of different clinical manifestations of COVID-19 as we manage these patients with no historical experience, to provide adequate care.

Stroke in patients with COVID-19: Clinical and neuroimaging characteristics

“…Interestingly, some case reports suggest a potential correlation between COVID-19 and arterial dissection involving extra-cranial vertebral artery [ 11 , 49 ] or carotid artery [ 50 ], including patients with unremarkable medical history or cardio-vascular risk factors. In one case [ 51 ], cervical vertebral artery dissection was associated with digital subtraction angiography-confirmed reversible cerebral vasoconstriction syndrome (RCVS) involving the anterior circulation associated with bilateral frontal subarachnoid hemorrhage (SAH).…”

The COVID-19 Arterial Thromboembolic Complications: From Inflammation to Immunothrombosis Through Antiphospholipid Autoantibodies

“… 11 In perspective, this pathological cascade is not the unique possible because endothelial ulcerations and necrotic-inflammatory lesions of the tunica media could produce an “intramural hematoma”, further complicating with an arterial dissection, if not bordered on by the prompt action of procoagulants. 12 Contrariwise, direct connections between “inflammatory” aneurysms and COVID-19 remain uncertain, although the breakdown of collagen structures, cytokines-related, together with occlusive microthromboses of vasa vasorum ( Fig. 1 C) are promoting factors.…”

Causality in COVID-19-associated stroke: a uniform case definition for use in clinical research

“…1 a–g) [ 3 – 5 , 8 ]. In addition, less frequent presentations were also observed: onset with seizures and/or encephalopathy [ 3 , 4 ], extra-cranial dissection [ 4 , 11 , 12 ], including bilateral carotid artery dissection [ 12 ] (Fig. 1 h–j), and posterior reversible encephalopathy (PRES) [ 4 ] or laminar cortical damage [ 13 ].…”