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Stroke ; 52(5): e117-e130, 2021 05.
Article in English | MEDLINE | ID: covidwho-1195876
Neurol Sci ; 42(7): 2611-2614, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1188106


Amongst the neurologic complications of COVID-19 disease, very few reports have shown the presence of the virus in the cerebrospinal fluid (CSF). Seizure and rarely status epilepticus can be associated with COVID-19 disease. Here we present a 73-year-old male with prior history of stroke who has never experienced seizure before. He had no systemic presentation of COVID-19 disease. The presenting symptoms were two consecutive generalized tonic-clonic seizures that after initial resolution turned into a nonconvulsive status epilepticus despite antiepileptic treatment (a presentation similar to NORSE (new-onset refractory status epilepticus)). There was no new lesion in the brain magnetic resonance imaging (MRI). The CSF analysis only showed an increased protein levels and positive reverse transcription polymerase chain reaction (RT-PCR) of 2019-nCoV. Patient recovered partially after anesthetic, IVIG, steroid, and remdesivir. To our knowledge, this is the first report of a refractory status epilepticus with the presence of SARS-CoV-2 ribonucleic acid (RNA) in the CSF.

COVID-19 , Status Epilepticus , Aged , Humans , Male , RNA , SARS-CoV-2 , Seizures/complications , Seizures/diagnostic imaging , Seizures/drug therapy , Status Epilepticus/complications , Status Epilepticus/diagnostic imaging , Status Epilepticus/drug therapy
Cerebrovasc Dis ; 50(2): 239-244, 2021.
Article in English | MEDLINE | ID: covidwho-977569


Ischemic stroke seems to be one of the most serious neurologic complications in patients with COVID-19 infection. Herein, we report a series of 10 ischemic stroke patients with concomitant COVID-19 disease. Out of 10, 8 had large infarcts (3 massive middle cerebral artery, 2 basilar artery, 2 posterior cerebral artery, and 1 internal carotid artery infarct territory). Two had cardiogenic embolic stroke due to atrial fibrillation. Almost half of our patients did not have a vascular risk factor. Nine did not have fever and were diagnosed with COVID-19 upon admission for stroke. Stroke occurred in the first week of respiratory symptoms with moderate pulmonary involvement. Most Patients did not have hypoxia and did not establish respiratory failure or acute respiratory distress syndrome. The blood pressures were low and hemorrhagic transformation did not occur even after antiplatelet or anticoagulant therapy. Patients had markedly increased levels of lactate dehydrogenase, C-reactive protein, and D-dimer. Three patients died. It seems that ischemic strokes in COVID-19 patients tend to occur as large infarct and can be seen in patients with mild to moderate pulmonary involvement.

Anticoagulants/pharmacology , COVID-19/complications , Ischemic Stroke/etiology , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Atrial Fibrillation/virology , COVID-19/virology , Female , Humans , Male , Middle Aged , Risk Factors , SARS-CoV-2/pathogenicity , Stroke/complications , Stroke/therapy