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1.
J Am Heart Assoc ; 10(22): e022433, 2021 11 16.
Article in English | MEDLINE | ID: covidwho-1511553

ABSTRACT

Background The relationship between COVID-19 and ischemic stroke is poorly understood due to potential unmeasured confounding and reverse causation. We aimed to leverage genetic data to triangulate reported associations. Methods and Results Analyses primarily focused on critical COVID-19, defined as hospitalization with COVID-19 requiring respiratory support or resulting in death. Cross-trait linkage disequilibrium score regression was used to estimate genetic correlations of critical COVID-19 with ischemic stroke, other related cardiovascular outcomes, and risk factors common to both COVID-19 and cardiovascular disease (body mass index, smoking and chronic inflammation, estimated using C-reactive protein). Mendelian randomization analysis was performed to investigate whether liability to critical COVID-19 was associated with increased risk of any cardiovascular outcome for which genetic correlation was identified. There was evidence of genetic correlation between critical COVID-19 and ischemic stroke (rg=0.29, false discovery rate [FDR]=0.012), body mass index (rg=0.21, FDR=0.00002), and C-reactive protein (rg=0.20, FDR=0.00035), but no other trait investigated. In Mendelian randomization, liability to critical COVID-19 was associated with increased risk of ischemic stroke (odds ratio [OR] per logOR increase in genetically predicted critical COVID-19 liability 1.03, 95% CI 1.00-1.06, P-value=0.03). Similar estimates were obtained for ischemic stroke subtypes. Consistent estimates were also obtained when performing statistical sensitivity analyses more robust to the inclusion of pleiotropic variants, including multivariable Mendelian randomization analyses adjusting for potential genetic confounding through body mass index, smoking, and chronic inflammation. There was no evidence to suggest that genetic liability to ischemic stroke increased the risk of critical COVID-19. Conclusions These data support that liability to critical COVID-19 is associated with an increased risk of ischemic stroke. The host response predisposing to severe COVID-19 is likely to increase the risk of ischemic stroke, independent of other potentially mitigating risk factors.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Body Mass Index , Brain Ischemia/epidemiology , Brain Ischemia/genetics , Brain Ischemia/virology , C-Reactive Protein , COVID-19/epidemiology , Genome-Wide Association Study , Humans , Inflammation , Ischemic Stroke/epidemiology , Ischemic Stroke/genetics , Ischemic Stroke/virology , Mendelian Randomization Analysis , Polymorphism, Single Nucleotide , Risk Factors , Smoking
2.
Pediatr Infect Dis J ; 40(9): e340-e343, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1370831

ABSTRACT

AIM: To describe a term newborn with acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem involvement including seizures associated to ischemic lesions in the brain. BACKGROUND: Coronavirus disease 2019 (COVID-19) is predominantly a respiratory infection, but it may affect many other systems. Most pediatric COVID-19 cases range from asymptomatic to mild-moderate disease. There are no specific clinical signs described for neonatal COVID-19 infections. In children, severe central nervous system compromise has been rarely reported. CASE DESCRIPTION: We describe a 17-day-old newborn who acquired a SARS-CoV-2 infection in a family meeting that was admitted for fever, seizures and lethargy and in whom consumption coagulopathy, ischemic lesions in the brain and cardiac involvement were documented. CONCLUSIONS: SARS-CoV-2 neonatal infection can be associated with multi-organic involvement. In our patient, significant central nervous system compromise associated to ischemic lesions and laboratory findings of consumption coagulopathy were found. CLINICAL SIGNIFICANCE: Although neonatal SARS-CoV-2 infections are infrequent, they can be associated with multi-organic involvement. Neonatologists and pediatricians should be aware of this unusual way of presentation of COVID-19 in newborn infants.


Subject(s)
Brain Ischemia/virology , COVID-19/complications , Infant, Newborn, Diseases/virology , SARS-CoV-2/isolation & purification , Acyclovir/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Brain/diagnostic imaging , Brain Ischemia/pathology , COVID-19/drug therapy , COVID-19/pathology , Ceftriaxone/therapeutic use , Fever , Frontal Lobe/blood supply , Frontal Lobe/diagnostic imaging , Frontal Lobe/pathology , Humans , Infant, Newborn , Infant, Newborn, Diseases/drug therapy , Infant, Newborn, Diseases/pathology , Lethargy , Magnetic Resonance Imaging , Male , Nasopharynx/virology , Seizures
3.
Stroke ; 52(5): 1885-1894, 2021 05.
Article in English | MEDLINE | ID: covidwho-1166635

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 or coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the correlation with this viral illness and increased risk of stroke. Although it is too early in the pandemic to know the strength of the association between COVID-19 and stroke, it is an opportune time to review the relationship between acute viral illnesses and stroke. Here, we summarize pathophysiological principles and available literature to guide understanding of how viruses may contribute to ischemic stroke. After a review of inflammatory mechanisms, we summarize relevant pathophysiological principles of vasculopathy, hypercoagulability, and hemodynamic instability. We will end by discussing mechanisms by which several well-known viruses may cause stroke in an effort to inform our understanding of the relationship between COVID-19 and stroke.


Subject(s)
Brain Ischemia/complications , Brain Ischemia/physiopathology , COVID-19/complications , COVID-19/epidemiology , Ischemic Stroke/complications , Ischemic Stroke/physiopathology , Acute Disease , Blood Coagulation , Brain Ischemia/virology , Hemodynamics , Herpesvirus 3, Human , Humans , Inflammation/physiopathology , Ischemic Stroke/virology , Pandemics , Plaque, Atherosclerotic/physiopathology , Risk , Thrombophilia/physiopathology , Thrombosis/physiopathology , Vascular Diseases/physiopathology , Virus Diseases/physiopathology
4.
Rev. Soc. Bras. Med. Trop ; 53: e20200692, 2020. graf
Article in English | LILACS (Americas) | ID: covidwho-1024438

ABSTRACT

Abstract A 56-year-old male with human immunodeficiency virus required hospitalization due to the onset of both dyspnea and asthenia. A computed tomography of the chest exam showed the radiological pattern of coronavirus SARS-CoV-2 pulmonary involvement. Based on immunochromatographic analysis, the patient evolved as a reagent for immunoglobulin M (IgM) and immunoglobulin G (IgG) anti-SARS-CoV-2 antibodies. The individual developed complete hemiparesis with a predominance in the right arm and conduction aphasia. T1-weighted magnetic resonance sequence of the brain showed an area of hypointensity with a high intrinsic cortical signal and hyperintensity in the T2-sequence. A Doppler velocimetric examination showed total/critical sub occlusion, suggesting an ischemic stroke.


Subject(s)
Humans , Male , HIV Infections/complications , Brain Ischemia/virology , Coronavirus Infections/complications , Immunoglobulin G , Immunoglobulin M , Magnetic Resonance Imaging , Brain Ischemia/diagnostic imaging , Coinfection/virology , Betacoronavirus , Middle Aged , Antibodies, Viral
5.
Stroke ; 52(2): 716-721, 2021 01.
Article in English | MEDLINE | ID: covidwho-999364

ABSTRACT

BACKGROUND AND PURPOSE: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many countries have introduced strict hygiene measures of social distancing to prevent further spreading of the disease. This may have led to a decreased presentation to hospital of patients with acute medical conditions and time-dependent management, such as stroke. METHODS: We conducted a nationwide cohort study using administrative database of all hospitalized patients with main diagnosis of acute ischemic stroke (AIS), transient ischemic attack, or intracerebral hemorrhage. Data from a total of 1463 hospitals in Germany were included. We compared case numbers and treatment characteristics of pandemic (March 16 to May 15, 2020) and prepandemic (January 16 to March 15, 2020) cases and also with corresponding time period in 2019. RESULTS: We identified a strong decline for hospitalization of AIS (-17.4%), transient ischemic attack (-22.9%), and intracerebral hemorrhage (-15.8%) patients during the pandemic compared with prepandemic period. IVT rate in patients with AIS was comparable (prepandemic versus pandemic: 16.4% versus 16.6%, P=0.448), whereas mechanical thrombectomy rate was significantly higher during the pandemic (8.1% versus 7.7%, P=0.044). In-hospital mortality was significantly increased in patients with AIS during the pandemic period (8.1% versus 7.6%, P=0.006). CONCLUSIONS: Besides a massive decrease in absolute case numbers, our data suggest that patients with AIS who did seek acute care during the pandemic, continued to receive acute recanalization treatment in Germany.


Subject(s)
Brain Ischemia/epidemiology , Brain Ischemia/virology , COVID-19/epidemiology , Stroke/epidemiology , Stroke/virology , Aged, 80 and over , Female , Germany , Humans , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/virology , Male , Middle Aged , Patient Care/statistics & numerical data , SARS-CoV-2/pathogenicity
6.
Front Immunol ; 11: 610696, 2020.
Article in English | MEDLINE | ID: covidwho-993359

ABSTRACT

Both neutrophil extracellular traps (NETs) and von Willebrand factor (VWF) are essential for thrombosis and inflammation. During these processes, a complex series of events, including endothelial activation, NET formation, VWF secretion, and blood cell adhesion, aggregation and activation, occurs in an ordered manner in the vasculature. The adhesive activity of VWF multimers is regulated by a specific metalloprotease ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motifs, member 13). Increasing evidence indicates that the interaction between NETs and VWF contributes to arterial and venous thrombosis as well as inflammation. Furthermore, contents released from activated neutrophils or NETs induce the reduction of ADAMTS13 activity, which may occur in both thrombotic microangiopathies (TMAs) and acute ischemic stroke (AIS). Recently, NET is considered as a driver of endothelial damage and immunothrombosis in COVID-19. In addition, the levels of VWF and ADAMTS13 can predict the mortality of COVID-19. In this review, we summarize the biological characteristics and interactions of NETs, VWF, and ADAMTS13, and discuss their roles in TMAs, AIS, and COVID-19. Targeting the NET-VWF axis may be a novel therapeutic strategy for inflammation-associated TMAs, AIS, and COVID-19.


Subject(s)
ADAMTS13 Protein/immunology , COVID-19/immunology , Extracellular Traps/immunology , SARS-CoV-2/immunology , Thrombosis/immunology , von Willebrand Factor/immunology , Acute Disease , Brain Ischemia/immunology , Brain Ischemia/pathology , Brain Ischemia/virology , COVID-19/pathology , Humans , Stroke/immunology , Stroke/pathology , Stroke/virology , Thrombosis/pathology , Thrombosis/virology , Thrombotic Microangiopathies/immunology , Thrombotic Microangiopathies/pathology , Thrombotic Microangiopathies/virology
7.
Ideggyogy Sz ; 73(11-12): 427-430, 2020 Nov 30.
Article in Hungarian | MEDLINE | ID: covidwho-953180

ABSTRACT

The clinical signs of SARS-CoV-2 infection has become more recognisable in recent times. In addition to common symptoms such as fever, cough, dyspnea, pneumonia and ageusia, less common complications can be identified, including many neurological manifestations. In this paper, we discuss three Covid-19 associated neurological disorders (Case 1: Covid-19 encephalitis, Case 2: Covid-19 organic headache, Case 3: SARS-CoV-2-infection and ischaemic stroke). We emphasize in our multiple case study that during the present pandemic, it is especially important for neurologists to be aware of the nervous system complications of the virus infection, thus saving unnecessary examinations and reducing the frequency of patients' contact with health care personnel.


Subject(s)
Brain Ischemia/virology , COVID-19 , Coronavirus Infections/diagnosis , Headache/virology , Pneumonia, Viral/diagnosis , Stroke/virology , Brain Ischemia/complications , Coronavirus , Coronavirus Infections/complications , Encephalitis , Headache/complications , Humans , Nervous System Diseases/complications , Nervous System Diseases/virology , Pneumonia, Viral/complications , Stroke/complications
9.
Pan Afr Med J ; 35(Suppl 2): 65, 2020.
Article in English | MEDLINE | ID: covidwho-886479

ABSTRACT

Introduction: Coronavirus is a virus with potential to target the nervous and respiratory systems. The aim of this work is to establish the prevalence of strokes in COVID19 positive patients in Guinea. Methods: All patients with stroke confirmed by brain imaging and COVID-positive PCR were included in this study. Retrospective patient data were obtained from medical records. Informed consent was obtained. Results: The RT-PCR confirmed the initial diagnosis and the chest CT scan provided a good diagnostic orientation. Brain imaging identified ischemic brain lesions. We report the case of four patients with stroke and a COVID-19 incidental finding in Guinea. Conclusion: This work shows that the onset of ischemic stroke associated with COVID-19 is generally delayed, but can occur both early and late in the course of the disease. More attention is needed because the early symptoms of viral attack are not just pulmonary.


Subject(s)
Brain Ischemia/diagnostic imaging , COVID-19/complications , Ischemic Stroke/diagnostic imaging , Aged , Brain Ischemia/virology , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Female , Guinea , Humans , Ischemic Stroke/virology , Male , Middle Aged , Retrospective Studies
10.
Neurol Sci ; 41(12): 3401-3404, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-842509

ABSTRACT

We describe the case of a COVID-19 patient with severely impaired consciousness after sedation hold, showing magnetic resonance imaging (MRI) findings of (i) acute bilateral supratentorial ischemic lesions involving the fronto-parietal white matter and the corpus callosum and (ii) multiple diffuse susceptibility weighted imaging (SWI) hypointense foci, infra and supratentorial, predominantly bithalamic, suggestive of microhemorrhage or alternatively microthrombi. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA was detected in the cerebrospinal fluid. Our findings suggest the occurrence of vascular damage, predominantly involving microvessels. The underlying mechanisms, which include direct and indirect penetration of the virus to the central nervous system and systemic cardiorespiratory complications, are yet to be elucidated, and a direct correlation with SARS-CoV-2 infection remains uncertain.


Subject(s)
Brain Ischemia/pathology , Brain Ischemia/virology , Coronavirus Infections/complications , Microvessels/pathology , Pneumonia, Viral/complications , Aged , Betacoronavirus , COVID-19 , Diabetes Mellitus , Fatal Outcome , Humans , Hypertension/complications , Male , Pandemics , SARS-CoV-2
11.
PLoS One ; 15(9): e0239443, 2020.
Article in English | MEDLINE | ID: covidwho-781671

ABSTRACT

OBJECTIVE: In the setting of the Coronavirus Disease 2019 (COVID-19) global pandemic caused by SARS-CoV-2, a potential association of this disease with stroke has been suggested. We aimed to describe the characteristics of patients who were admitted with COVID-19 and had an acute ischemic stroke (AIS). METHODS: This is a case series of PCR-confirmed COVID-19 patients with ischemic stroke admitted to an academic health system in metropolitan Atlanta, Georgia (USA) between March 24th, 2020 and July 17th, 2020. Demographic, clinical, and radiographic characteristics were described. RESULTS: Of 396 ischemic stroke patients admitted during this study period, 13 (2.5%) were also diagnosed with COVID-19. The mean age of patients was 61.6 ± 10.8 years, 10 (76.9%) male, 8 (61.5%) were Black Americans, mean time from last normal was 4.97 ± 5.1 days, and only one received acute reperfusion therapy. All 13 patients had at least one stroke-associated co-morbidity. The predominant pattern of ischemic stroke was embolic with 4 explained by atrial fibrillation. COVID-19 patients had a significantly higher rate of cryptogenic stroke than non-COVID-19 patients during the study period (69% vs 17%, p = 0.0001). CONCLUSIONS: In our case series, ischemic stroke affected COVID-19 patients with traditional stroke risk factors at an age typically seen in non-COVID populations, and mainly affecting males and Black Americans. We observed a predominantly embolic pattern of stroke with a higher than expected rate of cryptogenic strokes, a prolonged median time to presentation and symptom recognition limiting the use of acute reperfusion treatments. These results highlight the need for increased community awareness, early identification, and management of AIS in COVID-19 patients.


Subject(s)
Betacoronavirus , Brain Ischemia/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/etiology , African Americans , Aged , Atrial Fibrillation/complications , Brain Ischemia/ethnology , Brain Ischemia/virology , COVID-19 , Comorbidity , Coronavirus Infections/ethnology , Disease Management , Early Diagnosis , Embolism/complications , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/ethnology , SARS-CoV-2 , Stroke/ethnology , Stroke/virology
13.
Neuroepidemiology ; 54(5): 370-374, 2020.
Article in English | MEDLINE | ID: covidwho-713643

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) causes the coronavirus disease 2019 (COVID-19). It quickly became pandemic, and so did a new concern about COVID-19 infections increasing the risk for cerebrovascular diseases. There is an association between COVID-19 illness in people and acute stroke. Several chemical, mechanical, and/or inflammatory central nervous system pathologies are proposed to explain how this viral infection might induce acute cerebrovascular disease. Timely available evaluation and/or intervention is imperative for patients with concerns about acute cerebrovascular issues.


Subject(s)
Betacoronavirus , Brain/virology , Cerebrovascular Circulation/physiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/etiology , Stroke/virology , Betacoronavirus/metabolism , Brain/metabolism , Brain Ischemia/etiology , Brain Ischemia/metabolism , Brain Ischemia/virology , COVID-19 , Coronavirus Infections/metabolism , Humans , Pandemics , Pneumonia, Viral/metabolism , SARS-CoV-2 , Stroke/metabolism
14.
J Thromb Thrombolysis ; 50(3): 587-595, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-640827

ABSTRACT

Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection. Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain. We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients. A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020. All studies reporting AIS occurrence in COVID-19 patients were included. A total of 39 studies comprising 135 patients were studied. The pooled incidence of AIS in COVID-19 patients from observational studies was 1.2% (54/4466) with a mean age of 63.4 ± 13.1 years. The mean duration of AIS from COVID-19 symptoms onset was 10 ± 8 days, and the mean NIHSS score was 19 ± 8. Laboratory investigations revealed an elevated mean D-dimer (9.2 ± 14.8 mg/L) and fibrinogen (5.8 ± 2.0 g/L). Antiphospholipid antibodies were detected in a significant number of cases. The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62.1%, 64/103), followed by multiple vascular territory (26.2%, 27/103). A high mortality rate was reported (38.0%, 49/129). We report the pooled incidence of AIS in COVID-19 patients to be 1.2%, with a high mortality rate. Elevated D-dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis.


Subject(s)
Betacoronavirus/pathogenicity , Brain Ischemia/epidemiology , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Stroke/epidemiology , Aged , Brain Ischemia/diagnosis , Brain Ischemia/mortality , Brain Ischemia/virology , COVID-19 , Cause of Death , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/virology , Female , Host-Pathogen Interactions , Humans , Incidence , Male , Middle Aged , Observational Studies as Topic , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Prevalence , Prognosis , Risk Assessment , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Stroke/diagnosis , Stroke/mortality , Stroke/virology , Time Factors
16.
Int J Stroke ; 15(7): 733-742, 2020 10.
Article in English | MEDLINE | ID: covidwho-636180

ABSTRACT

BACKGROUND: The coronavirus disease 2019 is associated with neurological manifestations including stroke. OBJECTIVES: We present a case series of coronavirus disease 2019 patients from two institutions with acute cerebrovascular pathologies. In addition, we present a pooled analysis of published data on large vessel occlusion in the setting of coronavirus disease 2019 and a concise summary of the pathophysiology of acute cerebrovascular disease in the setting of coronavirus disease 2019. METHODS: A retrospective study across two institutions was conducted between 20 March 2020 and 20 May 2020, for patients developing acute cerebrovascular disease and diagnosed with coronavirus disease 2019. We performed a literature review using the PubMed search engine. RESULTS: The total sample size was 22 patients. The mean age was 59.5 years, and 12 patients were female. The cerebrovascular pathologies were 17 cases of acute ischemic stroke, 3 cases of aneurysm rupture, and 2 cases of sinus thrombosis. Of the stroke and sinus thrombosis patients, the mean National Institute of Health Stroke Scale was 13.8 ± 8.0, and 16 (84.2%) patients underwent a mechanical thrombectomy procedure. A favorable thrombolysis in cerebral infarction score was achieved in all patients. Of the 16 patients that underwent a mechanical thrombectomy, the mortality incidence was five (31.3%). Of all patients (22), three (13.6%) patients developed hemorrhagic conversion requiring decompressive surgery. Eleven (50%) patients had a poor functional status (modified Rankin Score 3-6) at discharge, and the total mortality incidence was eight (36.4%). CONCLUSIONS: Despite timely intervention and favorable reperfusion, the mortality rate in coronavirus disease 2019 patients with large vessel occlusion was high in our series and in the pooled analysis. Notable features were younger age group, involvement of both the arterial and venous vasculature, multivessel involvement, and complicated procedures due to the clot consistency and burden.


Subject(s)
Betacoronavirus , Brain Ischemia/epidemiology , Brain Ischemia/virology , Coronavirus Infections/complications , Intracranial Hemorrhages/epidemiology , Intracranial Hemorrhages/virology , Pneumonia, Viral/complications , Acute Disease , Adult , Aged , Brain Ischemia/diagnosis , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Humans , Intracranial Hemorrhages/diagnosis , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Retrospective Studies , SARS-CoV-2 , Survival Rate
17.
Diagn Pathol ; 15(1): 78, 2020 Jun 29.
Article in English | MEDLINE | ID: covidwho-617314

ABSTRACT

BACKGROUND: The outbreak of a novel coronavirus since December 2019, became an emergency of major international concern. As of June 21, 2020, the SARS-CoV-2 pandemic has caused 8,769,844 confirmed infections with 463,745 fatal cases worldwide. The SARS-CoV-2 outbreak is a major challenge for clinicians. In our clinic, we found a rare case that a COVID-19 patient combined with ischemic stroke. CASE PRESENTATION: A 79-year-old man was admitted to the Hubei Provincial Hospital of Traditional Chinese Medicine due to right limb weakness for 1 day and slight cough for 1 week. At presentation, his oxygen saturation was 94.2% on room air and body temperature was 37.3 °C (99.0 °F) with some moist rales. Neurological examination showed right limb weakness, and the limb muscle strength was grade 4. The left leg and arms were unaffected. In addition, runs of speech were not fluent enough with tongue deviation. Laboratory studies showed lymphopenia and eosinophilic granulocytopenia. Chest CT revealed bilateral pulmonary parenchymal ground-glass and consolidative pulmonary opacities, with a peripheral lung distribution. Real-time polymerase chain reaction (RT-PCR) from throat swab sample was positive for SARS-CoV-2 nucleic acid. This patient was treated with antiviral drugs and anti-inflammatory drugs with supportive care until his discharge. Clopidogrel (75 mg) and atorvastatin (20 mg) were administered orally to treat acute ischemic stroke. After 12 days of treatment, he can walk normally and communicate with near fluent language. CONCLUSION: We report an even more unusual case, a patient who was hospitalized for right limb weakness and was later diagnosed with COVID-19. Here, SARS-CoV-2 infection caused hypoxemia and excessive secretion of inflammatory cytokines, which contribute to the occurrence and development of ischemic stroke. Once COVID-19 patients show acute ischemic stroke, neurologists should cooperate with infectious disease doctors to help patients.


Subject(s)
Betacoronavirus , Brain Ischemia/virology , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Stroke/virology , Aged , Betacoronavirus/isolation & purification , Brain Ischemia/diagnosis , COVID-19 , COVID-19 Testing , COVID-19 Vaccines , Coronavirus Infections/complications , Humans , Male , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2 , Stroke/diagnosis
18.
Biochem Biophys Res Commun ; 528(3): 413-419, 2020 07 30.
Article in English | MEDLINE | ID: covidwho-436643

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic. It has a high transmission rate among humans, and is a threat to global public health. However, there are no effective prophylactics or therapeutics available. It is necessary to identify vulnerable and susceptible groups for adequate protection and care against this disease. Recent studies have reported that COVID-19 has angiotensin-converting enzyme 2 (ACE2) as a functional receptor, which may lead to the development of severe cerebrovascular diseases (CVD), including strokes, in patients with risk factors for CVD such as diabetes and smoking. Thus, the World Health Organization (WHO) advised caution against COVID-19 for smokers and patients with underlying clinical symptoms, including cardiovascular diseases. Here, we observed ACE2 expression in the brain of rat middle cerebral artery occlusion (MCAO) model and evaluated the effects of cigarette smoke extract (CSE) and diabetes on ACE2 expression in vessels. We showed that the levels of ACE2 expression was increased in the cortex penumbra after ischemic injuries. CSE treatment significantly elevated ACE2 expression in human brain vessels. We found that ACE2 expression was upregulated in primary cultured human blood vessels with diabetes compared to healthy controls. This study demonstrates that ACE2 expression is increased in ischemic brains and vessels exposed to diabetes or smoking, makes them vulnerable to COVID-19 infection.


Subject(s)
Betacoronavirus/metabolism , Brain Ischemia/virology , Brain/blood supply , Diabetes Mellitus , Peptidyl-Dipeptidase A/biosynthesis , Receptors, Virus/biosynthesis , Smokers , Stroke/virology , Up-Regulation , Angiotensin-Converting Enzyme 2 , Animals , Betacoronavirus/pathogenicity , Brain/drug effects , Brain Ischemia/genetics , Brain Ischemia/metabolism , COVID-19 , Coronavirus Infections/genetics , Coronavirus Infections/metabolism , Coronavirus Infections/virology , Diabetes Mellitus/genetics , Diabetes Mellitus/metabolism , Disease Models, Animal , Disease Susceptibility , Infarction, Middle Cerebral Artery/complications , Male , Mice , Mice, Inbred C57BL , Pandemics , Peptidyl-Dipeptidase A/genetics , Pneumonia, Viral/genetics , Pneumonia, Viral/metabolism , Pneumonia, Viral/virology , Rats , Rats, Sprague-Dawley , Receptors, Virus/genetics , SARS-CoV-2 , Smoke/adverse effects , Stroke/genetics , Stroke/metabolism , Up-Regulation/drug effects
19.
J Stroke Cerebrovasc Dis ; 29(8): 104980, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-343178

ABSTRACT

BACKGROUND: The COVID-19 pandemic has presented unprecedented challenges to healthcare organizations worldwide. A steadily rising number of patients requiring intensive care, a large proportion from racial and ethnic minorities, demands creative solutions to provide high-quality care while ensuring healthcare worker safety in the face of limited resources. Boston Medical Center has been particularly affected due to the underserved patient population we care for and the increased risk of ischemic stroke in patients with COVID-19 infection. METHODS: We present protocol modifications developed to manage patients with acute ischemic stroke in a safe and effective manner while prioritizing judicious use of personal protective equipment and intensive care unit resources. CONCLUSION: We feel this information will benefit other organizations facing similar obstacles in caring for the most vulnerable patient populations during this ongoing public health crisis.


Subject(s)
Betacoronavirus/pathogenicity , Brain Ischemia/virology , Coronavirus Infections/therapy , Endovascular Procedures , Health Services Needs and Demand/organization & administration , Needs Assessment/organization & administration , Pneumonia, Viral/therapy , Radiography, Interventional , Stroke/therapy , Thrombolytic Therapy , Boston , Brain Ischemia/diagnosis , Brain Ischemia/epidemiology , COVID-19 , Clinical Decision-Making , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Critical Pathways/organization & administration , Endovascular Procedures/adverse effects , Host Microbial Interactions , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Radiography, Interventional/adverse effects , Risk Assessment , Risk Factors , SARS-CoV-2 , Stroke/diagnosis , Stroke/epidemiology , Thrombolytic Therapy/adverse effects , Treatment Outcome , Triage/organization & administration
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