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1.
authorea preprints; 2024.
Preprint in English | PREPRINT-AUTHOREA PREPRINTS | ID: ppzbmed-10.22541.au.170667295.56604017.v1

ABSTRACT

The COVID-19 pandemic decreased the hospitalizations rate for acute coronary syndromes. The origin was multifactorial. In parallel, the incidence of mechanical complications after acute myocardial infarction increased. Is presented the case of a 54-years-olds female with COVID-19 and acute anterior myocardial infarction, apical aneurysm, and interventricular septal rupture. The surgical repair consisted of ventriculoplasty, septal rupture closure with a pericardial patch, and it was impossible to perform coronary revascularization.


Subject(s)
Myocardial Infarction , Aneurysm , COVID-19 , Coronary Disease , Ventricular Septal Rupture
2.
J Investig Med High Impact Case Rep ; 11: 23247096231166672, 2023.
Article in English | MEDLINE | ID: covidwho-2305300

ABSTRACT

We present an adolescent male with a single intracardiac mass and pulmonary emboli, complicated by peripheral venous thrombosis and subsequent development of pulmonary pseudoaneurysms, leading to diagnosis of Hughes-Stovin syndrome. Remission was achieved with cyclophosphamide, corticosteroids, and pseudoaneurysm resection and maintained with infliximab and methotrexate.


Subject(s)
Aneurysm, False , Aneurysm , Thrombosis , Vasculitis , Male , Humans , Adolescent , Aneurysm, False/complications , Aneurysm, False/therapy , Syndrome , Pulmonary Artery , Aneurysm/complications , Aneurysm/diagnosis , Vasculitis/complications , Thrombosis/drug therapy , Thrombosis/etiology
3.
Int J Mol Sci ; 24(4)2023 Feb 05.
Article in English | MEDLINE | ID: covidwho-2270710

ABSTRACT

Hughes-Stovin syndrome is a rare disease characterized by thrombophlebitis and multiple pulmonary and/or bronchial aneurysms. The etiology and pathogenesis of HSS are incompletely known. The current consensus is that vasculitis underlies the pathogenic process, and pulmonary thrombosis follows arterial wall inflammation. As such, Hughes-Stovin syndrome may belong to the vascular cluster with lung involvement of Behçet syndrome, although oral aphtae, arthritis, and uveitis are rarely found. Behçet syndrome is a multifactorial polygenic disease with genetic, epigenetic, environmental, and mostly immunological contributors. The different Behçet syndrome phenotypes are presumably based upon different genetic determinants involving more than one pathogenic pathway. Hughes-Stovin syndrome may have common pathways with fibromuscular dysplasias and other diseases evolving with vascular aneurysms. We describe a Hughes-Stovin syndrome case fulfilling the Behçet syndrome criteria. A MYLK variant of unknown significance was detected, along with other heterozygous mutations in genes that may impact angiogenesis pathways. We discuss the possible involvement of these genetic findings, as well as other potential common determinants of Behçet/Hughes-Stovin syndrome and aneurysms in vascular Behçet syndrome. Recent advances in diagnostic techniques, including genetic testing, could help diagnose a specific Behçet syndrome subtype and other associated conditions to personalize the disease management.


Subject(s)
Aneurysm , Behcet Syndrome , Vasculitis , Humans , Aneurysm/complications , Aneurysm/diagnosis , Aneurysm/pathology , Behcet Syndrome/diagnosis , Pulmonary Artery/pathology , Vasculitis/pathology
5.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.02.16.23285979

ABSTRACT

Multisystem inflammatory syndrome in children temporally associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death. This multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression. The study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysm were found in 5.7% and 13.2% of the patients, respectively. The rate of mortality due to SARS-CoV-2-related factors was 4.6%. Delay of [≥]10 days in hospital admission was associated with coronary artery aneurysm or dilatation (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2- 2.0). Age [≥] 10 years (OR 5.6, 95% CI 1.4- 2.04), severe underlying condition (OR 9.3, 95% CI 2.8- 31.0), platelet count < 150,000/mm3 (OR 4.2, 95% CI 1.2- 14.7), international normalized ratio > 1.2 at admission (OR 3.8, 95% CI 1.05- 13.9), and serum ferritin concentration > 1500 mg/dL (OR 52, 95% CI 5.9- 463) were risk factors for death.


Subject(s)
Cryopyrin-Associated Periodic Syndromes , Death , Coronary Aneurysm , Aneurysm , Severe Acute Respiratory Syndrome , COVID-19 , Shock
6.
biorxiv; 2022.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2022.09.26.508411

ABSTRACT

Background and Aim Coronary involvement in Kawasaki Disease (KD), whether its after SARS-CoV2 infection or not, can result in significant complications. There is the risk of aneurysm formation associated with inflammation and an unremitting fever. We wished to study the Vasoactive Endothelial Growth Factor (VEGF) and Heat Shock Response from a gene-expression perspective. Thereby aiming to furnish to insights that might be useful in the treatment of Kawasaki Disease. Method KD datasets based on previous work, were selected including microarray studies KD1 (GSE63881), KD2 (GSE73461), KD3 (GSE68004) and the RNAseq dataset KD4 (GSE64486) from the NCBI online repository. Based on clinical literature. HSP genes shown to be associated with angiogenesis were chosen for analysis as well as gene expression for VEFGA and VEGFB. Further in order to gain an impression of inflammatory patterns, gene expression for NFKB1 and TNF were also chosen. Tools for analysis included Gene Set Expression Analysis (GSEA). A KEGG pathway, outlining a relationship between VEGF and endothelial migration and proliferation was assumed. Results A KD dataset showed increased VEGFA and decreased VEGFB in acute versus convalescent samples. In all three KD datasets, HSPA1A and HSBAP1 genes were upregulated in acute versus convalescent samples. In KD4, cases of KD versus controls, VEGFB was down-regulated (p = 4.932e-02) and HSPBAP1 up-regulated (p = 1.202e-03). GSEA of KD1, KD2 and KD3, using Hallmark gene sets, suggested an inflammatory response with TNFA signaling via NFKB, IL6 JAK STAT 3 signaling, apoptosis, angiogenesis, and unfolded protein response. Conclusions A novel application of a model of VEGF and HSP to KD was presented. Coronary pathogenesis based on VEGF and HSP was explored. The ability to follow angiogenesis at the molecular level using a VEGF-HSP model may have therapeutic implications. Further, the significance of gene expression between VEGFA, VEGFB in KD and the relationship of HSP gene expression to angiogenesis in KD requires further study.


Subject(s)
Fever , Mucocutaneous Lymph Node Syndrome , Inflammation , Coronary Aneurysm , Aneurysm
7.
Am J Cardiol ; 172: 115-120, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1838526

ABSTRACT

Previous studies have shown that bovine arch incidence is higher in patients with thoracic aortic aneurysms than in patients without an aneurysm. Although thoracic aortic aneurysm disease is known to be familial in some cases, it remains unknown if bovine arch results from a genetic mutation, thus allowing it to be inherited. Our objective was to determine the heritability of bovine arch from phenotypic pedigrees. We identified 24 probands from an institutional database of 202 living patients with bovine arch who had previously been diagnosed with thoracic aortic aneurysm and who had family members with previous chest computed tomography or magnetic resonance imaging scans. Aortic arch configuration of all first-degree and second-degree relatives was determined from available scans. Heritability of bovine arch was estimated using maximum-likelihood-based variance decomposition methodology implemented by way of the SOLAR package (University of Maryland, Catonsville, Maryland). 43 relatives of 24 probands with bovine arch had preexisting imaging available for review. The prevalence of bovine arch in relatives with chest imaging was 53% (n = 23) and did not differ significantly by gender (male: 64.3%, female: 55.6%, p = 1). The bovine arch was shown to be highly heritable with a heritability estimate (h2) of 0.71 (p = 0.048). In conclusion, the high heritability of bovine arch in our sample population suggests a genetic basis.


Subject(s)
Aneurysm , Aortic Aneurysm, Thoracic , Aneurysm/complications , Aorta, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/epidemiology , Aortic Aneurysm, Thoracic/genetics , Female , Humans , Incidence , Likelihood Functions , Male , Retrospective Studies
8.
Front Immunol ; 12: 780804, 2021.
Article in English | MEDLINE | ID: covidwho-1648493

ABSTRACT

Objectives: Currently, cardiovascular risk associated with COVID-19 has been brought to people's attention, but the mechanism is not clear. The aim of this study is to elucidate the mechanisms based on multiple omics data. Methodology: Weighted gene co-expression network analysis (WGCNA) was used to identify key pathways. Combination analysis with aneurysm and atherosclerosis related pathways, hypoxia induced factor-1 (HIF-1) signaling were identified as key pathways of the increased cardiovascular risk associated with COVID-19. ScMLnet algorithm based on scRNA-seq was used to explore the regulation of HIF-1 pathway by intercellular communication. Proteomic analysis was used to detect the regulatory mechanisms between IL18 and HIF-1 signaling pathway. Pseudo time locus analysis was used to study the regulation of HIF1 signaling pathway in macrophages and vascular smooth muscle cells (VSMC) phenotypic transformation. The Virtual Inference of protein-activity by Enriched Regulon (VIPER) analysis was used to study the activity of regulatory proteins. Epigenetic analysis based on methylation revealed epigenetic changes in PBMC after SARS-CoV-2 infection. Potential therapeutic compounds were explored by using Cmap algorithm. Results: HIF-1 signaling pathway is a common key pathway for aneurysms, atherosclerosis and SARS-CoV-2 infection. Intercellular communication analysis showed that macrophage-derived interleukin-18 (IL-18) activates the HIF-1 signaling pathway through IL18R1. Proteomic analysis showed that IL18/IL18R1 promote NF-κB entry into the nucleus, and activated the HIF-1 signaling pathway. Macrophage-derived IL18 promoted the M1 polarization of macrophages and the syntactic phenotype transformation of VSMCs. MAP2K1 mediates the functional regulation of HIF-1 signaling pathway in various cell types. Epigenetic changes in PBMC after COVID-19 infection are characterized by activation of the type I interferon pathway. MEK inhibitors are the promising compounds for the treatment of HIF-1 overactivation. Conclusions: The IL18/IL18R1/HIF1A axis is expected to be an therapeutic target for cardiovascular protection after SARS-CoV-2 infection. MEK inhibitors may be an choice for cardiovascular protection after SARS-COV-2 infection.


Subject(s)
Aneurysm/etiology , Aneurysm/metabolism , Atherosclerosis/etiology , Atherosclerosis/metabolism , COVID-19/blood , COVID-19/complications , Hypoxia-Inducible Factor 1, alpha Subunit/metabolism , Interleukin-18 Receptor alpha Subunit/metabolism , Interleukin-18/metabolism , SARS-CoV-2 , Signal Transduction , Aneurysm/pathology , Atherosclerosis/pathology , COVID-19/virology , Case-Control Studies , Cells, Cultured , Epigenesis, Genetic , Humans , Interferon Type I/metabolism , Leukocytes, Mononuclear/metabolism , Macrophages/metabolism , Myocytes, Smooth Muscle/metabolism , NF-kappa B/metabolism , Proteomics/methods , RNA-Seq/methods , Risk Factors , Single-Cell Analysis/methods
9.
Ann Vasc Surg ; 79: 127-129, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1458538

ABSTRACT

We describe the story of a 70- year-old Italian male that almost 4 months later respiratory infection by SARS-CoV-2 presented a rapid evolution of a true aneurism of the right posterior tibial artery (PTA).


Subject(s)
Aneurysm/etiology , COVID-19/complications , Tibial Arteries , Aged , Aneurysm/diagnostic imaging , Aneurysm/surgery , COVID-19/diagnosis , Humans , Male , Tibial Arteries/diagnostic imaging , Tibial Arteries/surgery , Treatment Outcome
10.
Ann Vasc Surg ; 63: 461.e1-461.e5, 2020 Feb.
Article in English | MEDLINE | ID: covidwho-1454027

ABSTRACT

A 70-year-old man was scheduled for the robotic resection of a 21×16 × 30 mm thymic nodule incidentally detected by a computed tomography scan (CT) for thoracic trauma after a domestic accident. Positron emission tomography (PET) scan confirmed a low [18F]-FDG uptake (SUVmax = 1,9). During the surgery, the mass showed to be a saccular aneurysm of the left brachiocephalic vein (LBCV). A complete tangential resection of the aneurysm, with the use of EndoGIA stapler (Covidien® Endo GIA™) at its origin, was performed. The patient's recovery was uneventful, and postoperative CT with contrast administration confirmed the patency of the vein.


Subject(s)
Aneurysm/surgery , Brachiocephalic Veins/surgery , Positron-Emission Tomography , Robotic Surgical Procedures , Surgical Stapling , Thymoma/diagnostic imaging , Thymus Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Vascular System Injuries/surgery , Aged , Aneurysm/diagnostic imaging , Brachiocephalic Veins/diagnostic imaging , Diagnosis, Differential , Diagnostic Errors , Humans , Incidental Findings , Male , Predictive Value of Tests , Treatment Outcome , Vascular System Injuries/diagnostic imaging
11.
Curr Rheumatol Rev ; 18(1): 83-87, 2022.
Article in English | MEDLINE | ID: covidwho-1430604

ABSTRACT

BACKGROUND: Behçet's disease (BD) is a complex vasculitis with some vascular manifestations including venous thrombosis, arterial thrombosis/aneurysm/pseudoaneurysm, and co-associated venous thrombosis and arterial lesions. We present two patients with Behçet's disease came with progressive both arterial and venous involvement. CASE PRESENTATION: The first patient was a young man with recurrent oral aphthosis and skin folliculitis and referred with complaint of new abdominal pain and 2 months severe headache. He had not referred to a physician due to COVID-19 pandemic until that time. In addition, he gradually developed a lower extremity edema and eventually was diagnosed with BD complicated with brain sagittal sinus vein thrombosis, abdominal aortic aneurysms and aortitis and deep vein thrombosis (DVT) of femoral vein. The second patient was a young woman with previous history of uveitis, DVT and recurrent oral and genital aphthosis presented with a large inguinal mass due to large iliac artery pseudoaneurysm impending to rupture, and after the operation, due to poor follow-up, developed a new femoral DVT. CONCLUSION: It seems the same inflammatory process is responsible for arterial and venous involvement in patients with BD, so it should be considered that involvement in one side (venous/arterial) can be a risk factor for the other side (venous/arterial) and early immunosuppressive treatment should always be considered to improve the prognosis.


Subject(s)
Aneurysm, False , Aneurysm , Aortitis , Behcet Syndrome , COVID-19 , Thrombosis , Venous Thrombosis , Aneurysm/complications , Aneurysm/surgery , Aneurysm, False/complications , Aortitis/complications , Behcet Syndrome/complications , Behcet Syndrome/diagnosis , COVID-19/complications , Female , Humans , Male , Pandemics , Thrombosis/complications , Venous Thrombosis/complications
12.
researchsquare; 2021.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-853134.v1

ABSTRACT

Background: Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However, the prevalence of rhino-cerebral mucormycosis has been reported to increase after the coronavirus disease 2019 (COVID-19) pandemic. Methods Three patients with stroke and subarachnoid hemorrhage due to ICA aneurysm after the involvement of adjacent paranasal sinuses with mucormycosis were presented. All patients were recruited from Namazi and Khalili hospitals affiliated with Shiraz University of Medical Sciences in Iran from April 2021 to May 2021. Results They had a history of diabetes and corticosteroid use. Also, one of them was treated with imatinib. Two out of three patients were infected with SARS-CoV-2 infection before developing mucormycosis. Two patients had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling, and only this patient survived. Although all patients received antifungal treatment and surgical debridement, two of them died. Conclusions In the patients with rhino-cerebral mucormycosis evolving of aneurysm should be promptly and meticulously investigated by magnetic resonance angiography (MRA) and computed tomography angiography (CTA). As this type of aneurysms was very fast-growing, as soon as the involvement of sphenoid sinus was detected, the possibility of ICA aneurysm formation should always be kept in mind. If the patient developed an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.


Subject(s)
Diabetes Mellitus , Subarachnoid Hemorrhage , Mucormycosis , Aneurysm , COVID-19 , Carotid Artery Diseases , Aneurysm, Infected
13.
researchsquare; 2021.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-741390.v1

ABSTRACT

We here discuss an interesting case of COVID-19 patient suffering from ruptured right supra-clinoid intracranial aneurysm with congenital absence of right ICA. COVID-19 has been responsible for over 175 million reported cases and over 3.8 million deaths world-wide. Severe cases of COVID-19 is characterized with cytokine outburst and hyperinflammation, platelet activation, endothelial dysfunction and sepsis related coagulopathy. This predisposes for thromboembolic events and aneurysm formation and rupture. Agenesis, aplasia and hypoplasia of internal carotid artery (ICA) is a rare congenital anomaly. ICA agenesis is associated with increased incidence of intracranial aneurysm as compared with general population.


Subject(s)
Thromboembolism , Disseminated Intravascular Coagulation , Intracranial Aneurysm , COVID-19 , Aneurysm , Carotid Artery Diseases , Congenital Abnormalities , Iridocorneal Endothelial Syndrome
14.
J Telemed Telecare ; 28(4): 296-300, 2022 May.
Article in English | MEDLINE | ID: covidwho-1166683

ABSTRACT

A patient presented with acute onset of double vision during the start of the COVID-19 pandemic when elective medical care was restricted. Initially declining an in-person evaluation, she was examined using a telehealth video visit, incorporating multiple technological modalities to ascertain ophthalmic examination elements. Her findings prompted emergent neuroimaging, revealing a giant internal carotid artery aneurysm, which was successfully embolized to prevent debilitating and possibly fatal intracranial haemorrhage. This case report illustrates the successful use of telemedicine and remote patient data acquisition to make a life-saving diagnosis.


Subject(s)
Aneurysm , COVID-19 , Telemedicine , COVID-19/complications , Carotid Artery, Internal/diagnostic imaging , Diplopia/diagnosis , Diplopia/etiology , Female , Humans , Pandemics , Telemedicine/methods
15.
Interact Cardiovasc Thorac Surg ; 33(1): 150-152, 2021 06 28.
Article in English | MEDLINE | ID: covidwho-1118995

ABSTRACT

We report a rare case of solitary peripheral pulmonary artery aneurysm in a patient who was evaluated for haemoptysis. Incidentally, his total antibodies were positive for Coronavirus 2019 infection. Patient underwent right lower lobectomy uneventfully. Peripheral pulmonary artery aneurysms arising from segmental or intrapulmonary branches are extremely rare. Untreated, the majority end fatally due to sudden rupture and exsanguination. The purpose of this article is to report our rare case and review the pertinent literature.


Subject(s)
Aneurysm/pathology , Pulmonary Artery/pathology , Adult , Aneurysm/diagnostic imaging , Aneurysm/surgery , Humans , Male , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Tomography, X-Ray Computed
17.
researchsquare; 2020.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-65060.v1

ABSTRACT

Objectives: The aim of our study was to assess the frequency distribution of relevant and incidental vascular events in a retrospective cohort of 42 COVID-19 patients. Methods: All patients were studied by whole-body CT angiography.Twenty-three out of 42 patients were admitted to the intensive care unit (ICU). Results: Relevant vascular events were recorded in the 71.4% of the whole study population. Pulmonary embolism was the most frequent one both in ICU and no-ICU cases (56.5% vs10.5%, p=0.002). Ischemic infarction of other organs was affecting with an increasing prevalence the gut, the spleen, the liver, the brain and the kidney, with a simultaneous ischemic occurrence in some cases. Multi-focal venous thrombosis was also represented especially in ICU patients (p=0.005). Among incidental findings, splanchnic vessels little-size aneurysms were reported in the 40% of the whole population, with relative frequencies similarly distributed in ICU and no-ICU patients.Conclusions: Vascular involvement is not negligible in COVID-19 and should be carefully investigated as may significantly affect disease behavior and prognosis.


Subject(s)
Pulmonary Embolism , Ischemia , Aneurysm , COVID-19 , Infarction , Venous Thrombosis
18.
Clin Neuroradiol ; 31(3): 653-659, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-723015

ABSTRACT

PURPOSE: Intracerebral hemorrhage (ICH) accounts for up to 20% of all strokes, and there is a high rate of associated morbidity and mortality. Computed tomography (CT) findings, such as a spot sign have been shown to be an independent predictor of poor outcome. We have recently encountered a succession of ICH patients who presented with a peculiar imaging finding, which we term the spot on a string sign. This is a rare imaging finding, and interestingly, all these patients presented to our institution over the last few weeks. METHODS: This was a single high-volume center series of patients who presented to our institution between 1 April and 21 May 2020. All patients underwent initial non-contrast CT brain and subsequent CT angiography (CTA). We also present laboratory and clinical data. Our primary measure was the presence of the spot on a string sign on the CTA. We also report the clinical course of these patients. RESULTS: In this study seven large-volume ICH patients with this imaging sign were identified, with a median age of 48 years (range 30-68 years). All had tested negative for coronavirus disease 19 (COVID-19). CONCLUSION: We have described an unusual imaging finding in a cohort of younger patients with large-volume ICH, all of whom presented in a 2-month period to a high-volume neurovascular unit. The cause of these ICH presentations and associated imaging findings are unclear, but we encourage other clinicians to be aware of and vigilant for this rare phenomenon, especially in younger patients with such a bleeding pattern.


Subject(s)
Aneurysm , COVID-19 , Cerebral Hemorrhage , Adult , Aged , Cerebral Angiography , Cerebral Hemorrhage/diagnostic imaging , Female , Hematoma , Humans , Male , Middle Aged , SARS-CoV-2
19.
Shima Shahjouei; Georgios Tsivgoulis; Ghasem Farahmand; Eric Koza; Ashkhan Mowla; Alireza Vafaei Sadr; Arash Kia; Alaleh Vaghefi Far; Stefania Mondello; Achille Cernigliaro; Annemarei Ranta; Martin Punter; Faezeh Khodadadi; Mrina Sabra; Mahtab Ramezani; Soheil Naderi; Oluwaseyi Olulana; Durgesh Chaudhary; Aicha Lyoubi; Bruce Campbell; Juan F Arenillas; Daniel Bock; Joan Montaner; Saeideh Aghayari Sheikh Neshin; Diana Aguiar de Sousa; Mattew Tenser; Ana Aires; Mercedes De Lera Alfonso; Orkhan Alizada; Elsa Azevedo; Nitin Goyal; Zabihollah Babaeepour; Gelareh Banihashemi; Leo H Bonati; Carlo Cereda; Jason J Chang; Miljenko Crnjakovic; GianMarco De Marchis; Massimo del Sette; Seyed Amir Ebrahimadeh; Mehdi Farhoudi; Ilaria Gandoglia; Bruno Goncalves; Christoph Griessenauer; Mehmet Murat Hanci; Aristeidis H. Katsanos; Christos Krogias; Ronen Leker; Lev Lotman; Jeffrey Mai; Shailesh Male; konark Malhotra; Branko Malojcic; Tresa Mesquita; Asadollah Mirghasemi; Hany Mohamed Aref; Zeinab Mohseni Afshar; Junsun Moon; Mika Niemela; Behnam Rezai Jahromi; Lawrence Nolan; Abhi Pandhi; Jong-Ho Park; Joao Pedro Marto; Francisco Purroy; Sakineh Ranji-Burachaloo; Nuno Reis Carreira; Manuel Requena; Marta Rubiera; Seyed Aidin Sajedi; Joao SargentoFreitas; Vijay Sharma; Thorsten Steiner; Kristi Tempro; Guillaume Turc; Yassaman Ahmadzadeh; Mostafa Almasi-Dooghaee; Farhad Assarzadegan; Arefeh Babazadeh; Humain Baharvahdat; Fabricio Cardoso; Apoorva Dev; Mohammad Ghorbani; Ava Hamidi; Zeynab Sadat Hasheminejad; Sahar Hojjat-Anasri Komachali; Fariborz Khorvash; Firas Kobeissy; Hamidreza Mirkarimi; Elahe Mohammadi-Vosough; Debdipto Misra; Alierza Noorian; Peyman Nowrouzi-Sohrabi; Sepideh Paybast; Leila Poorsaadat; mehrdad Roozbeh; Behnam Sabayan; Saeideh Salehizadeh; Alia Saberi; Mercedeh Sepehrnia; Fahimeh Vahabizad; Thomas Yasuda; Ahmadreza Hojati Marvasti; Mojdeh Ghabaee; Nasrin Rahimian; Mohammad Hosein Harirchian; Afshin Borhani-Haghighi; Rohan Arora; Saeed Ansari; Venkatesh Avula; Jian Li; Vida Abedi; Ramin Zand.
medrxiv; 2020.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2020.08.05.20169169

ABSTRACT

Background: Stroke is reported as a consequence of SARS-CoV-2 infection. However, there is a lack of regarding comprehensive stroke phenotype and characteristics Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients. We further investigated the association of demographics, clinical data, geographical regions, and countrie's health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. Conclusions: We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. Among hospitalized patients, the stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.


Subject(s)
Stroke , Subarachnoid Hemorrhage , Arterial Occlusive Diseases , Aneurysm , Severe Acute Respiratory Syndrome , COVID-19 , Sinus Thrombosis, Intracranial , Intracranial Hemorrhages
20.
researchsquare; 2020.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-48374.v1

ABSTRACT

BackgroundSARS-CoV-2 virus infection leads to a severe and dysbalanced inflammatory response with hypercytokinemia and immunodepression. Systemic inflammation due to viral infections can potentially cause vascular damage including disruption of blood-brain barrier (BBB) and alterations in coagulation system that may also lead to cardiovascular and neurovascular events. Here, we report the first case of COVID-19 infection leading to aneurysmal subarachnoid haemorrhage (aSAH). Case DescriptionA 61-year-old woman presented with dyspnea, cough and fever. She was over weight with Body mass-index of 34 and history of hypertension. No history of subarachnoid hemorrhage in the family. She was admitted in ICU due to low oxygen saturation (89%). A chest CT showed typical picture of COVID-19 pneumonia. Oropharyngeal swab with a PCR-based testing was COVID-19 positive. She was prescribed with favipiravir and hydroxychloroquine in Addition to oxygen support. On second day she experienced sudden headache and losst conciousness. A computer tomography (CT) with CT-angiography revealed subarachnoid haemorrhage in basal cisterns from a ruptured anterior communicating artery aneurysm. The aneurysm was clipped microsurgically through a standard pterional approach and the patient was admitted again to intensive care unit for further intensive medical treatment. Post-operative the patient showed slight motor dysphasia. No other neurological deficits.ConclusionAneurysmal subarachnoid haemorrhage secondary to COVID-19 infection might be triggered by systemic inflammation. COVID-19 infection could be one of the risk factors leading to instability and rupture of intracranial aneurysm.


Subject(s)
Cerebrovascular Disorders , Inflammation , Subarachnoid Hemorrhage , Hypertension , Pneumonia , Headache , Virus Diseases , COVID-19 , Intracranial Aneurysm , Aneurysm , Cough , Aphasia , Dyspnea
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