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2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(10): 25-31, 2021.
Article in Russian | MEDLINE | ID: covidwho-1555601

ABSTRACT

OBJECTIVE: Analysis of the results of emergency carotid endarterectomy (CEE) in internal carotid artery (ICA) thrombosis in the acute period of acute cerebrovascular accident (ACVI) in patients with COVID-19. MATERIAL AND METHODS: During the COVID-19 pandemic (April 1, 2020 - May 1, 2021), 43 patients with ICA thrombosis and a positive polymerase chain reaction (PCR) result for SARS-CoV-2 were included in this prospective study. In all cases, CEE was performed in the acutest period of ACVA. These patients were included in group 1. The comparison group was represented by 89 patients who underwent CEE in the acute period of stroke, in the period before the COVID-19 pandemic (April 1, 2019 - March 1.2020). RESULTS: In the hospital postoperative period, the groups were comparable in terms of the incidence of deaths (group 1: 2.3%, n=1; group 2: 1.1%, n=1; p=0.81; OR=2.09; 95% CI=0.12-34.3) myocardial infarction (group 1: 2.3%, n=1; group 2: 0%; p=0.7; OR=6.3; 95% CI=0.25-158.5), CVA (group 1: 2.3%, n=1; group 2: 2.2%, n=2; p=0.55; OR=1.03; 95% CI=0.09-11.,7). ICA thrombosis and hemorrhagic transformations were not recorded. However, in view of severe coagulopathy with ongoing anticoagulant/antiplatelet therapy, patients with COVID-19 more often developed bleeding in the operation area (group 1: 11.6%, n=5; group 2: 1.1%, n=1; p=0.02; OR=11.5; 95% CI=1.3-102.5). CONCLUSION: Emergency CEE in the acute period of stroke is an effective and safe method of cerebral revascularization in case of ICA thrombosis in conditions of COVID-19.


Subject(s)
Brain Ischemia , COVID-19 , Carotid Artery Thrombosis , Carotid Stenosis , Endarterectomy, Carotid , Ischemic Stroke , Stroke , Brain Ischemia/complications , Carotid Artery, Internal/surgery , Humans , Pandemics , Prospective Studies , SARS-CoV-2 , Treatment Outcome
3.
J Stroke Cerebrovasc Dis ; 30(12): 106152, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1506161

ABSTRACT

Cerebrovascular diseases attributed to coronavirus disease 2019 (COVID-19) are uncommon but can result in devastating outcomes. Pediatric acute ischemic strokes are themselves rare and with very few large vessel occlusion related acute ischemic strokes attributed to COVID-19 described in the literature as of date. COVID-19 pandemic has contributed to acute stroke care delays across the world and with pediatric endovascular therapy still in its infancy, it poses a great challenge in facilitating good outcomes in children presenting with acute ischemic strokes in the setting of COVID-19. We present a pediatric patient who underwent endovascular therapy for an internal carotid artery occlusion related acute ischemic stroke in the setting of active COVID-19 and had an excellent outcome thanks to a streamlined stroke pathway involving the vascular neurology, neuro-interventional, neurocritical care, and anesthesiology teams.


Subject(s)
COVID-19/complications , Carotid Artery Thrombosis/therapy , Carotid Artery, Internal , Carotid Stenosis/therapy , Endovascular Procedures , Ischemic Stroke/therapy , Thrombectomy , COVID-19/diagnosis , Carotid Artery Thrombosis/diagnosis , Carotid Artery Thrombosis/etiology , Carotid Artery, Internal/diagnostic imaging , Carotid Stenosis/diagnosis , Carotid Stenosis/etiology , Child , Endovascular Procedures/instrumentation , Humans , Ischemic Stroke/diagnosis , Ischemic Stroke/etiology , Male , Stents , Treatment Outcome
4.
Ann Vasc Surg ; 79: 438.e1-438.e4, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1456980

ABSTRACT

BACKGROUND: Vaccine Induced Thrombotic Thrombocytopenia (VITT) is a rare complication following ChAdOx1 (AstraZeneca) vaccination. Venous thrombosis in unusual sites such as splachnic or intracranial thrombosis, is the commonest manifestation. CASE REPORT: We report a 35-year-old male patient who presented with acute left leg ischemia and thrombocytopenia 11-days after vaccination requiring emergent thrombectomy. During work-up, a localized thrombus was detected in the left carotid bifurcation mandating carotid thrombectomy. Localized right iliac thrombus causing a non-limiting flow stenosis was treated conservatively. The platelet aggregating capacity of patient's plasma was confirmed in a functional assay, thereby establishing VITT. CONCLUSION: To the best of our knowledge this is the first case presenting multiple arterial thromboses requiring surgical treatment after ChAdOx1 vaccination.


Subject(s)
Arterial Occlusive Diseases/surgery , Carotid Artery Thrombosis/surgery , Femoral Artery/surgery , Thrombectomy , Thrombosis/surgery , Vaccination/adverse effects , Adult , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Carotid Artery Thrombosis/diagnostic imaging , Carotid Artery Thrombosis/etiology , Femoral Artery/diagnostic imaging , Humans , Iliac Artery/diagnostic imaging , Male , Thrombosis/diagnostic imaging , Thrombosis/etiology , Treatment Outcome
6.
BMJ Case Rep ; 14(8)2021 Aug 03.
Article in English | MEDLINE | ID: covidwho-1341318

ABSTRACT

SARS-CoV-2 has proven its versatility in host presentations; one such presentation is a hypercoagulable state causing large-vessel thrombosis. We report a case on a previously asymptomatic COVID-19-positive patient presenting with an acute ischaemic stroke and an incidental left internal carotid artery thrombus. The patient's medical, social and family history and hypercoagulability screening excluded any other explanation for the left carotid thrombus or stroke, except for testing positive for the COVID-19. This case explores the known hypercoagulable state associated with COVID-19 and the effect of the virus on the host's immune response. It also questions whether administration of recombinant tissue plasminogen activator (t-PA), according to the American Heart Association guidelines, following a negative head CT for haemorrhagic stroke is safe without prior extended imaging in this patient population. We recommend, in addition to obtaining a non-contrast CT scan of the brain, a CT angiogram or carotid duplex of the neck be obtained routinely in patients with COVID-19 exhibiting stroke symptoms before t-PA administration as the effects may be detrimental. This recommendation will likely prevent fragmentation and embolisation of an undetected carotid thrombus.


Subject(s)
Brain Ischemia , COVID-19 , Carotid Artery Thrombosis , Ischemic Stroke , Stroke , Brain Ischemia/diagnostic imaging , Brain Ischemia/etiology , Carotid Artery Thrombosis/complications , Carotid Artery Thrombosis/diagnostic imaging , Carotid Artery Thrombosis/drug therapy , Female , Humans , SARS-CoV-2 , Stroke/drug therapy , Stroke/etiology , Tissue Plasminogen Activator/therapeutic use
7.
Clin Neurol Neurosurg ; 206: 106677, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1230410

ABSTRACT

Owing to systemic inflammation and widespread vessel endotheliopathy, SARS-CoV-2 has been shown to confer an increased risk of cryptogenic stroke, particularly in patients without any traditional risk factors. In this report, we present a case of a 67-year-old female who presented with acute stroke from bilateral anterior circulation large vessel occlusions, and was incidentally found to be COVID-positive on routine hospital admission screening. The patient had a large area of penumbra bilaterally, and the decision was made to pursue bilateral simultaneous thrombectomy, with two endovascular neurosurgeons working on each side to achieve a faster time to recanalization. Our study highlights the utility and efficacy of simultaneous bilateral thrombectomy, and this treatment paradigm should be considered for use in patients who present with multifocal large vessel occlusions.


Subject(s)
COVID-19/complications , Carotid Artery Thrombosis/surgery , Endovascular Procedures , Infarction, Middle Cerebral Artery/surgery , Stroke/etiology , Thrombectomy , Aged , Carotid Artery Thrombosis/diagnosis , Carotid Artery Thrombosis/etiology , Female , Humans , Infarction, Middle Cerebral Artery/diagnosis , Infarction, Middle Cerebral Artery/etiology
8.
J Neurol ; 268(12): 4443-4447, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1206873

ABSTRACT

COVID-19 (Coronavirus disease 2019) caused by SARS-CoV-2 has a diverse constellation of neurological manifestations that include encephalopathy, stroke, Guillain-Barré syndrome, myelitis, and encephalitis. Intraluminal carotid thrombi (ILT) are infrequent lesions seen in only 1.6% of patients with acute ischemic stroke. Underlying atherosclerosis is the most common lesion associated with ILT formation. However, with COVID-19, we have encountered ILT in patients without significant atherosclerotic disease. The endothelial inflammation and hypercoagulable state associated with COVID-19 pose a risk of arterial and venous thromboembolism and could have contributed to this presentation although the exact pathophysiology and optimal treatment of ILT in COVID-19 remain elusive. Herein, we present a series of ischemic stroke patients with carotid ILT in the setting of a recent SARS-CoV-2 infection.


Subject(s)
Brain Ischemia , COVID-19 , Carotid Artery Thrombosis , Ischemic Stroke , Stroke , Brain Ischemia/complications , Carotid Artery Thrombosis/complications , Carotid Artery Thrombosis/diagnostic imaging , Humans , SARS-CoV-2 , Stroke/complications
9.
Pan Afr Med J ; 38: 34, 2021.
Article in English | MEDLINE | ID: covidwho-1110742

ABSTRACT

Since December 2019, the world has experienced the emergence in China of a new infection called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This infection quickly has progressed to a global pandemic since March 2020, with very high human-to-human transmission rate. Besides lung injury, COVID-19 is also associated with cardio and neurovascular complications. Herein, we report the case of a 77-year-old female who presented with non-severe COVID-19 and multiple ischemic strokes secondary to an extensive carotid thrombosis. The ischemic stroke was supposed to have been caused by the cytokine storm related to COVID-19. The possibility of hemorrhagic transformation, based on the assessment of bleeding score, limited the use of anticoagulation, and probably explained the stroke recurrence and poor outcome in our patient. The pathogenic mechanism and the management of this complex situation are still lacking and further studies are needed.


Subject(s)
COVID-19/complications , Carotid Artery Thrombosis/etiology , Cytokine Release Syndrome/virology , Ischemic Stroke/etiology , Aged , Cytokine Release Syndrome/physiopathology , Female , Humans , Recurrence
10.
J Thromb Thrombolysis ; 51(4): 985-988, 2021 May.
Article in English | MEDLINE | ID: covidwho-1053058

ABSTRACT

OBJECTIVES: Infection with the SARS-COV2 virus (COVID-19) may be complicated by thrombotic diathesis. This complication often involves the pulmonary microcirculation. While macrovascular thrombotic complications of the lung may include pulmonary artery embolism, pulmonary artery thrombus in situ has also been hypothesized. Pulmonary vein thrombosis has not been described in this context. METHODS/RESULTS: Herein, we provide a case of an otherwise healthy male who developed an ischemic stroke with left internal carotid thrombus. Further imaging revealed pulmonary emboli with propagation through the pulmonary veins into the left atrium. This left atrial thrombus provides a source of atypical "paradoxic arterial embolism". CONCLUSIONS: Thrombotic outcomes in the setting of severe COVID 19 pneumonia may include macrovascular venous thromboembolism, microvascular pulmonary vascular thrombosis and arterial thromboembolism. Pulmonary vein, herein described, provides further mechanistic pathway for potential arterial embolic phenomenon.


Subject(s)
COVID-19 , Carotid Artery Thrombosis , Ischemic Stroke , Pulmonary Embolism , Pulmonary Veno-Occlusive Disease , Brain/diagnostic imaging , COVID-19/blood , COVID-19/complications , COVID-19/physiopathology , Carotid Artery Thrombosis/complications , Carotid Artery Thrombosis/diagnosis , Diagnosis, Differential , Heart Atria/diagnostic imaging , Heart Atria/pathology , Hemiplegia/diagnosis , Hemiplegia/etiology , Humans , Ischemic Stroke/diagnosis , Ischemic Stroke/etiology , Ischemic Stroke/physiopathology , Lung/diagnostic imaging , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Pulmonary Veno-Occlusive Disease/complications , Pulmonary Veno-Occlusive Disease/diagnosis , Pulmonary Veno-Occlusive Disease/physiopathology , SARS-CoV-2/pathogenicity , Tomography, X-Ray Computed/methods
11.
Colomb Med (Cali) ; 51(3): e504560, 2020 Sep 30.
Article in English | MEDLINE | ID: covidwho-1011880

ABSTRACT

CASE DESCRIPTION: 37-year-old female with PCR-RT swab for COVID-19 positive, with neurological manifestation as a result of internal carotid artery occlusion. CLINICAL FINDINGS: Nasal congestion and sneezing of 5 days duration; pulsatile headache in the left hemicranium 3 days prior to admission, with intensity 6/10 according to the visual analogue scale, accompanied by phosphenes, photophobia and diplopia; with subsequent developing right hemiparesis over a 26-hour period. TREATMENT AND RESULT: She was given medical management with oral antiplatelet agents and anticoagulants (subcutaneous and oral) during his hospitalization, it was not possible to perform thrombolysis and thrombectomy due to the high risk of complications. He was discharged at 14 days, without functional limitation, symmetrical strength in upper and lower limbs, bilateral visual acuity 20/20, denying headache. CLINICAL RELEVANCE: The case presented here describes a pattern in how data supporting an association between COVID-19 and stroke in young populations with or without typical vascular risk factors, sometimes with only mild respiratory symptoms, is increasing. Prospective studies are required to further evaluate this association, as well as anticoagulation studies to prevent these potentially life-threatening events.


DESCRIPCIÓN DEL CASO: Mujer de 37 años con hisopado PCR-RT para COVID-19 positivo, con manifestación neurológica por oclusión de la arteria carótida interna. HALLAZGOS CLÍNICOS: Congestión nasal y estornudos de 5 días de duración; cefalea pulsátil en hemicráneo izquierdo 3 días antes del ingreso, con intensidad 6/10 según la escala visual analógica, acompañada de fosfenos, fotofobia y diplopía; con posterior desarrollo de hemiparesia derecha durante un período de 26 horas. TRATAMIENTO Y RESULTADO: Se le brindó manejo médico con antiagregantes plaquetarios orales y anticoagulantes (subcutáneos y orales) durante su internación, no fue posible realizar trombólisis y trombectomía por alto riesgo de complicaciones. Fue dado de alta a los 14 días, sin limitación funcional, fuerza simétrica en miembros superiores e inferiores, agudeza visual bilateral 20/20, negando cefalea. RELEVANCIA CLÍNICA: Se describe un patrón que indica cómo están aumentando los datos que apoyan una asociación entre COVID-19 y el accidente cerebrovascular en poblaciones jóvenes con o sin factores de riesgo vascular típicos, a veces con solo síntomas respiratorios leves. Se requieren estudios prospectivos para evaluar más a fondo esta asociación, así como estudios de anticoagulación para prevenir estos eventos potencialmente mortales.


Subject(s)
COVID-19/complications , Carotid Artery Thrombosis/etiology , Carotid Artery, Internal/pathology , Adult , Anticoagulants/therapeutic use , COVID-19/diagnosis , Carotid Artery Thrombosis/diagnosis , Carotid Artery Thrombosis/drug therapy , Female , Humans , Platelet Aggregation Inhibitors/therapeutic use , Reverse Transcriptase Polymerase Chain Reaction
12.
World Neurosurg ; 144: 140-142, 2020 12.
Article in English | MEDLINE | ID: covidwho-800521

ABSTRACT

BACKGROUND: The occurrence of large-vessel occlusion in young patients with coronavirus disease 2019 (COVID-19) infection has been exceedingly rare. An extensive review of reported studies revealed a few reported cases. In the present report, we have described the clinical presentation, radiological findings, and outcome of large-vessel occlusion in a young patient with COVID-19 and reviewed the pertinent reported data on this condition. CASE DESCRIPTION: A 31-year-old woman was in her usual state of health until she had presented with a 3-day history of right-sided weakness, slurred speech, and decreased vision. The patient had been taken to several hospitals where she had been treated conservatively with analgesics and discharged. Shortly thereafter, her weakness had become progressive. She had become severely dysarthric and unresponsive. On arrival to the emergency department, her physical examination revealed that she was stuporous, with a Glasgow coma scale of 10 (eye response, 3; verbal response, 2; motor response, 5). The National Institutes of Health Stroke Scale score was 19 on presentation. Brain computed tomography and computed tomography venography revealed an occluded left internal carotid artery and left middle cerebral artery with subacute left middle cerebral artery territory infarction and midline shift. Computed tomography angiography revealed complete occlusion of the left common carotid artery. An emergent decompressive craniectomy was successfully performed. The patient was shifted to the intensive care unit. She was later found to be positive for COVID-19. CONCLUSIONS: Although rare, patients with COVID-19 can present with large-vessel occlusion. Prompt identification of COVID-19-related coagulopathy is essential to assess young patients with clinical manifestations of infarction.


Subject(s)
COVID-19/complications , Carotid Artery Thrombosis/etiology , Infarction, Middle Cerebral Artery/etiology , Adult , COVID-19/diagnosis , Carotid Artery Thrombosis/diagnostic imaging , Carotid Artery Thrombosis/surgery , Carotid Artery, Common , Computed Tomography Angiography , Decompressive Craniectomy , Dysarthria/etiology , Epilepsy/complications , Female , Hemiplegia/etiology , Humans , Hypertension/complications , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/surgery , Stupor/etiology , Tomography, X-Ray Computed
13.
AJNR Am J Neuroradiol ; 41(11): 1993-1995, 2020 11.
Article in English | MEDLINE | ID: covidwho-724382

ABSTRACT

We present a radiology-pathology case series of 3 patients with coronavirus disease 2019 (COVID-19) with acute ischemic stroke due to fulminant carotid thrombosis overlying mild atherosclerotic plaque and propose a novel stroke mechanism: COVID-associated carotid atherothrombosis.


Subject(s)
Carotid Artery Diseases/virology , Carotid Artery Thrombosis/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/etiology , Aged , Betacoronavirus , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , Plaque, Atherosclerotic/pathology , Risk Factors , SARS-CoV-2
14.
Clin Imaging ; 69: 94-101, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-653878

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a global pandemic, and it is increasingly important that physicians recognize and understand its atypical presentations. Neurological symptoms such as anosmia, altered mental status, headache, and myalgias may arise due to direct injury to the nervous system or by indirectly precipitating coagulopathies. We present the first COVID-19 related cases of carotid artery thrombosis and acute PRES-like leukoencephalopathy with multifocal hemorrhage.


Subject(s)
COVID-19 , Carotid Artery Thrombosis , Coronavirus Infections , Leukoencephalopathies , Pneumonia, Viral , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2
15.
J Thromb Haemost ; 18(8): 2031-2033, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-401717

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a pandemic disease currently affecting millions of people worldwide. Its neurological implications are poorly understood, and further study is urgently required. A hypercoagulable state has been reported in patients with severe COVID-19, but nothing is known about coagulopathy in patients with milder disease. We describe cases of patients in New York City presenting with stroke secondary to large vessel thrombosis without occlusion, incidentally found to have COVID-19 with only mild respiratory symptoms. This is in contrast to the venous thrombosis and microangiopathy that has been reported in patients with severe COVID-19. Our cases suggest that even in the absence of severe disease, patients with COVID-19 may be at increased risk of thrombus formation leading to stroke, perhaps resulting from viral involvement of the endothelium. Further systematic study is needed because this may have implications for primary and secondary stroke prevention in patients with COVID-19.


Subject(s)
Betacoronavirus , Carotid Artery Thrombosis/etiology , Coronavirus Infections/complications , Infarction, Middle Cerebral Artery/etiology , Pandemics , Pneumonia, Viral/complications , Adult , Aged , Anticoagulants/therapeutic use , Betacoronavirus/isolation & purification , Biomarkers , C-Reactive Protein/analysis , COVID-19 , Carotid Artery Thrombosis/blood , Carotid Artery Thrombosis/diagnostic imaging , Carotid Artery Thrombosis/drug therapy , Cerebral Angiography , Computed Tomography Angiography , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Emergencies , Female , Fibrin Fibrinogen Degradation Products/analysis , Hemiplegia/etiology , Humans , Infarction, Middle Cerebral Artery/blood , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/drug therapy , Magnetic Resonance Angiography , Male , Middle Aged , New York City/epidemiology , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Thrombophlebitis/complications
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