Stroke and COVID19: Not only a large-vessel disease

Abstract

Recent evidence has underlined the association between large-vessel stroke and COVID-19, probably due to a proinflammatory and prothrombotic microenvironment induced by SARS-CoV-2. Here, we report the case of a young fit woman affected by COVID-19 without any flu-like symptom, who suffered from speech disorder and left hemiparesis. Brain magnetic resonance evidenced two small acute brain infarctions in right perirolandic cortex without signs of previous ischemic lesions and hemorrhagic infarction. Diagnostic workup excluded cardiac embolic sources, acquired and inherited thrombophilia or autoimmune diseases. Two positive nasopharyngeal swab tests and high titers of serum specific IgA/IgM confirmed COVID-19 diagnosis. In our case stroke seems to be the only manifestation of SARS-COV-2 infection. Therefore the hypothesis of an underlying viral infection, as COVID-19, should be investigated in all the cases of small vessel cryptogenic stroke.

Neurological Complications of COVID-19 and Possible Neuroinvasion Pathways: A Systematic Review

“…In total, 6890 patients were included in the studies. Among the 68 studies on the CNS effects, 46 were case reports [ 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ], followed by 10 retrospective studies [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , …”

“…The main neurologic conditions associated to SARS-CoV-2 were found to be stroke, STDs and encephalopathy. In particular, 41% of the studies reported stroke as neurological complication [ 20 , 22 , 23 , 24 , 25 , 26 , 27 , 33 , 35 , 37 , 38 , 44 , 47 , 51 , 52 , 54 , 55 , 57 , 58 , 62 , 64 , 65 , 67 , 68 , 69 , 71 , 74 , 78 ], 26% reported STDs [ 34 , 36 , 40 , 46 , 49 , 50 , 66 , 73 , 75 , 76 , 77 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ] and 18% reported encephalopathy [ 17 , 30 , 31 , 32 , 39 , 42 , ...…”

“…The other patient was 67 years old with no pre-existing pathologies. Other three studies described the cases of ischemic stroke concomitant with COVID-19: the patient reported by Co and colleagues [25] was a 62-year-old woman with several pre-existing pathologies such as hypertension, diabetes, dyslipidemia and transient ischemic attack; the patient reported by Frisullo and colleagues [33] was a young woman with no concomitant pathologies, while Zhai and colleagues' [62] patient was a 79-year-old-man. Cerebrovascular complications caused by SARS-CoV-2 infection were also reported by Garaci and colleagues [35].…”

Insights Into Neuroimaging Findings of Patients With Coronavirus Disease 2019 Presenting With Neurological Manifestations

“…However, the mechanism of small vessel occlusion remains unclear and needs further investigation. Small cortical ischemic lesions were revealed by MRI in a COVID-19 patient while neither interstitial lung involvement nor abnormal serum inflammation markers were detected ( 31 ). Furthermore, a multicenter retrospective study comparing COVID-19 patients with non-COVID-19 patients from 1 year prior found that infection with COVID-19 was the strongest independent risk factor for stroke, followed by deep vein thrombosis and male sex ( 32 ).…”

Modelling the Anatomical Distribution of Neurological Events in COVID-19 Patients: A Systematic Review

“…White matter events were identified most frequently in the corticospinal tract and corpus patients. 8,38,42,46,60 Similarly, the corpus callosum plays an important role in interhemispheric communication; which can result in disconnection syndrome and broad neurocognitive deficits. 65 In grey matter regions, events were identified most frequently in the temporal and precentral gyrus as well as the bilateral thalamus.…”