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J Stroke Cerebrovasc Dis ; 30(12): 106118, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1415616


BACKGROUND AND OBJECTIVES: RCVS (Reversible Cerebral Vasoconstrictive Syndrome) is a condition associated with vasoactive agents that alter endothelial function. There is growing evidence that endothelial inflammation contributes to cerebrovascular disease in patients with coronavirus disease 2019 (COVID-19). In our study, we describe the clinical features, risk factors, and outcomes of RCVS in a multicenter case series of patients with COVID-19. MATERIALS AND METHODS: Multicenter retrospective case series. We collected clinical characteristics, imaging, and outcomes of patients with RCVS and COVID-19 identified at each participating site. RESULTS: Ten patients were identified, 7 women, ages 21 - 62 years. Risk factors included use of vasoconstrictive agents in 7 and history of migraine in 2. Presenting symptoms included thunderclap headache in 5 patients with recurrent headaches in 4. Eight were hypertensive on arrival to the hospital. Symptoms of COVID-19 included fever in 2, respiratory symptoms in 8, and gastrointestinal symptoms in 1. One patient did not have systemic COVID-19 symptoms. MRI showed subarachnoid hemorrhage in 3 cases, intraparenchymal hemorrhage in 2, acute ischemic stroke in 4, FLAIR hyperintensities in 2, and no abnormalities in 1 case. Neurovascular imaging showed focal segment irregularity and narrowing concerning for vasospasm of the left MCA in 4 cases and diffuse, multifocal narrowing of the intracranial vasculature in 6 cases. Outcomes varied, with 2 deaths, 2 remaining in the ICU, and 6 surviving to discharge with modified Rankin scale (mRS) scores of 0 (n=3), 2 (n=2), and 3 (n=1). CONCLUSIONS: Our series suggests that patients with COVID-19 may be at risk for RCVS, particularly in the setting of additional risk factors such as exposure to vasoactive agents. There was variability in the symptoms and severity of COVID-19, clinical characteristics, abnormalities on imaging, and mRS scores. However, a larger study is needed to validate a causal relationship between RCVS and COVID-19.

COVID-19/complications , Cerebral Arteries/physiopathology , Cerebrovascular Circulation , Vasoconstriction , Vasospasm, Intracranial/etiology , Adult , COVID-19/diagnosis , COVID-19/therapy , Cerebral Arteries/diagnostic imaging , Female , Humans , Male , Middle Aged , Neuroimaging , Retrospective Studies , Risk Factors , Severity of Illness Index , Syndrome , Time Factors , Treatment Outcome , United States , Vasospasm, Intracranial/diagnostic imaging , Vasospasm, Intracranial/physiopathology , Vasospasm, Intracranial/therapy , Young Adult
J Stroke Cerebrovasc Dis ; 30(7): 105822, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1179851


There have been limited cases linking SARS-CoV-2 infection with the development of reversible cerebral vasoconstriction syndrome (RCVS). We hereby report a rare case of RCVS in the setting of mild SARS-CoV-2 respiratory infection successfully treated with nimodipine and aspirin. SARS-CoV-2 attacks the ACE2-receptors, which are expressed in various body organs including the lungs, kidneys, and blood vessels. Vasoconstriction can result from down-regulation of the ACE2-receptors that can lead to sympathetic hypertonia of the cerebral blood vessel walls and/or over-activation of the renin-angiotensin axis.

Aspirin/therapeutic use , COVID-19/complications , Cerebral Arteries/drug effects , Nimodipine/therapeutic use , Vasoconstriction/drug effects , Vasodilator Agents/therapeutic use , Vasospasm, Intracranial/drug therapy , Adult , COVID-19/diagnosis , Cerebral Arteries/diagnostic imaging , Cerebral Arteries/physiopathology , Female , Humans , Syndrome , Treatment Outcome , Vasospasm, Intracranial/diagnostic imaging , Vasospasm, Intracranial/etiology , Vasospasm, Intracranial/physiopathology
J Stroke Cerebrovasc Dis ; 29(9): 105011, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-548355


The current COVID-19 pandemic has recently brought to attention the myriad of neuro- logic sequelae associated with Coronavirus infection including the predilection for stroke, particularly in young patients. Reversible cerebral vasoconstriction syndrome (RCVS) is a well-described clinical syndrome leading to vasoconstriction in the intracra- nial vessels, and has been associated with convexity subarachnoid hemorrhage and oc- casionally cervical artery dissection. It is usually reported in the context of a trigger such as medications, recreational drugs, or the postpartum state; however, it has not been described in COVID-19 infection. We report a case of both cervical vertebral ar- tery dissection as well as convexity subarachnoid hemorrhage due to RCVS, in a pa- tient with COVID-19 infection and no other triggers.

Betacoronavirus/pathogenicity , Cerebral Arteries/physiopathology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Subarachnoid Hemorrhage/complications , Vasoconstriction , Vertebral Artery Dissection/complications , Adult , COVID-19 , Cerebral Arteries/diagnostic imaging , Cerebral Arteries/drug effects , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Female , Headache Disorders, Primary/etiology , Headache Disorders, Primary/physiopathology , Host-Pathogen Interactions , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Risk Factors , SARS-CoV-2 , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/drug therapy , Subarachnoid Hemorrhage/physiopathology , Syndrome , Vasoconstriction/drug effects , Vasodilation , Vertebral Artery Dissection/diagnostic imaging , Vertebral Artery Dissection/drug therapy , Vertebral Artery Dissection/physiopathology