ABSTRACT
Stroke is a common and devastating event and the majority of cases are caused by thromboembolism from the left atrium, left ventricle or left sided valves. This case report describes a case of embolic stroke with the origin of the thrombus from the left inferior pulmonary vein. The importance of this case is twofold. Firstly, it is the fourth case report of pulmonary venous thrombosis, a very rare condition, due to COVID-19 infection and secondly, it focuses attention on the fact that the left atrium is not the most proximal address of arterial thromboembolism-the pulmonary veins are. Thus, it is proposed that a thorough assessment of the pulmonary veins should be done in all cases of arterial thromboembolism.
Subject(s)
COVID-19 , Embolic Stroke , Ischemic Stroke , Pulmonary Embolism , Pulmonary Veins , Thromboembolism , Venous Thrombosis , COVID-19/complications , Embolic Stroke/diagnostic imaging , Embolic Stroke/etiology , Humans , Pulmonary Embolism/etiology , Thromboembolism/complications , Venous Thrombosis/complicationsABSTRACT
OBJECTIVE: There have been no reports suggesting a relationship between the COVID-19 mRNA vaccines that encodes the spike glycoprotein of SARS-CoV-2 and cerebrovascular disease. A case of repeated cardioembolic stroke after vaccination with the BNT162b2 (Pfizer) COVID-19 mRNA vaccine is presented. METHODS: Imaging and laboratory findings, treatment decisions, and the outcome of this case are presented. RESULTS: An 83-year-old Japanese woman developed right hemiplegia and motor aphasia three days after receiving her first dose of the BNT162b2 (Pfizer) COVID-19 mRNA vaccine. She had been taking rivaroxaban for persistent atrial fibrillation for 10 years, but had no symptomatic ischemic strokes. On magnetic resonance imaging (MRI) the left middle cerebral artery (MCA) was occluded. Intravenous recombinant tissue-plasminogen activator (rt-PA) therapy and mechanical thrombectomy were performed, and she recovered almost fully. However, three days after the second dose, she developed left hemiplegia and left hemispatial neglect. MRI showed occlusion of the right MCA. Only mechanical thrombectomy was performed again, but it could not be resumed due to the hard thrombus. DISCUSSION: In this case, it is difficult to exclude a causal relationship between the COVID-19 mRNA vaccine and ischemic stroke. This association needs to be carefully monitored.
Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Embolic Stroke/complications , Aged, 80 and over , BNT162 Vaccine , COVID-19 Vaccines/administration & dosage , Embolic Stroke/etiology , Embolic Stroke/therapy , Female , Hemiplegia , Humans , Ischemic Stroke , Magnetic Resonance Imaging , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/etiology , Thrombectomy , Tissue Plasminogen Activator , Vaccination/adverse effectsABSTRACT
This commentary will focus on the role of thrombectomy for the treatment of embolic stroke during the 2019 novel coronavirus disease (COVID-19). We will begin with review of recently promulgated guidelines for use of thrombectomy in COVID-19-associated stroke. We will then survey the reported experience of thrombectomy applied to treatment of large-vessel occlusion (LVO) stroke in COVID-19. We will conclude by discussing unusual challenges confronted by neuro-interventionalists seeking to perform thrombectomy in COVID-19 patients with acute LVO stroke.