ABSTRACT
Background and aims: Coronavirus SARS-CoV-2 is currently the major public health concern worldwide with systemic complications, including thrombotic and hemorrhagic neurological manifestations. Methods: We report a series of patients admitted in the stroke unit of neurology department of the Military Hospital of Tunis in November 2020, presented with cerebrovascular symptoms as an initial presentation of SARS-CoV-2. Clinical characteristics and outcome of the patients are described. Results: Seven patients were included. Infection with SARS-CoV-2 was diagnosed through reverse transcription polymerase chain reaction (RT-PCR) of tracheal aspirate and a chest computed tomography (CT) scan. The main cerebrovascular manifestations are: acute ischemic stroke (AIS) in five patients, intracerebral hemorrhage in one case, with a left capsulo thalamic localization. One patient presented with cerebral venous thrombosis (CVT) in the left sigmoid sinus. All patients with AIS received antiplatelet therapy and statins. Treatment of COVID-19 infection with antibiotics, vitamins and preventive anticoagulant has been initiated. three patients developed dyspnea and oxygen desaturation with need of Oxygen support by face mask. One patient was transferred to the intensive care unit and required intubation, and one patient died after two days. The patient with CVT was started on full anticoagulation with unfractionated heparin relayed by oral anticoagulants. After one week, she was stabilized. Conclusion: SARS-CoV-2 is a major risk factor for cerebrovascular disease. Better understanding of these complications is urgent in order to improve the management of these patients.
ABSTRACT
Background and aims: Various neurological manifestations have been reported in association with the coronavirus disease of 2019 (COVID-19) and may be the initial or only presentations of the disease. Even, the virus increased risk of exacerbations of chronic neurological disorders. Methods: We conducted a prospective study in the department of neurology of the Military Hospital of Tunis from September 2020 to December 2020 including patients hospitalized for COVID-19 with neurological manifestations. The diagnosis was made by real-time reverse-transcription polymerase chain reaction (RT-PCR) analysis of nasal swab specimens. Results: 14 patients were included. Cerebrovascular complications of COVID-19 were: acute ischemic stroke (n=5), cerebral hemorrhage (n=1) and cerebral venous thrombosis of the sigmoid sinus (n=1). Two patients with previously stable myasthenia gravis had myasthenic exacerbation and one of them required intubation for hypoxemic respiratory failure. Decompensation of chronic neuroinflammatory disorders was observed in two cases: relapse of multiple sclerosis (n=1) and Neuro-Behçet's disease (n=1). One patient followed for epilepsy was hospitalized for uncontrolled seizure following infection with COVID-19, and two patients had clinical findings of encephalitis including confusion, headache and fever. The outcome was favorable for 12 patients who received symptomatic treatment of COVID-19 along with treatment for their disease. Two patients with ischemic stroke were died. Conclusion: In the current pandemic context, physicians should be aware of the broad spectrum of neurological signs of COVID-19 for early diagnosis and management of patients.