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2.
Pract Neurol ; 21(6): 518-520, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1526522

ABSTRACT

Loss of sense of taste (hypogeusia) involving a part of the tongue can follow acute stroke. We describe a woman with a small right thalamic acute infarct causing bilateral (mainly left-sided) hypogeusia. Her problem remains sufficiently severe to cause distress and nutritional deficit. The anatomical distribution of her problem-cheiro-oral syndrome with concurrent hypogeusia-suggested involvement of adjacent relevant thalamic fibres. We address key considerations in examining taste in research and in practice and discuss issues to address in people with hypogeusia, including swallow deficits, psychological elements of the poststroke condition and nutrition. Dietetic management should include optimising taste stimuli and nutritional support. Introducing more detailed taste assessments into standard practice would likely improve stroke unit care.


Subject(s)
Ageusia , Cerebral Infarction/complications , Cerebral Infarction/diagnostic imaging , Female , Humans , Taste , Thalamus/diagnostic imaging , Tongue
3.
J Neurovirol ; 27(6): 951-953, 2021 12.
Article in English | MEDLINE | ID: covidwho-1499531

ABSTRACT

The artery of Percheron is a small vessel whose occlusion causes bilateral paramedian thalamic and rostral midbrain stroke. COVID-19 is an independent risk factor for acute small vessel ischemic stroke. We presented the case of a young adult patient with infarction in the artery of Percheron territory as a presenting feature of COVID-19. Artery of Percheron infarction is a neurodiagnostic challenge in emergency during COVID-19 pandemic.


Subject(s)
COVID-19 , Arteries , COVID-19/complications , Cerebral Infarction/complications , Cerebral Infarction/diagnostic imaging , Humans , Pandemics , Thalamus/diagnostic imaging , Young Adult
4.
Childs Nerv Syst ; 38(2): 441-445, 2022 02.
Article in English | MEDLINE | ID: covidwho-1281269

ABSTRACT

Neurological manifestations, such as encephalitis, meningitis, ischemic, and hemorrhagic strokes, are reported with increasing frequency in patients affected by Coronavirus disease 2019 (COVID-19). In children, acute ischemic stroke is usually multifactorial: viral infection is an important precipitating factor for stroke. We present a case of a child with serological evidence of SARS-CoV-2 infection whose onset was a massive right cerebral artery ischemia that led to a malignant cerebral infarction. The patient underwent a life-saving decompressive hemicraniectomy, with good functional recovery, except for residual hemiplegia. During rehabilitation, the patient also developed a lower extremity peripheral nerve neuropathy, likely related to a long-Covid syndrome.


Subject(s)
Brain Ischemia , COVID-19 , Decompressive Craniectomy , Stroke , COVID-19/complications , Cerebral Infarction/complications , Cerebral Infarction/diagnostic imaging , Child , Humans , Infarction, Middle Cerebral Artery/surgery , SARS-CoV-2 , Stroke/surgery , Treatment Outcome
6.
AJNR Am J Neuroradiol ; 42(2): 257-261, 2021 01.
Article in English | MEDLINE | ID: covidwho-895284

ABSTRACT

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) appears to be an independent risk factor for stroke. We hypothesize that patients who develop stroke while hospitalized for severe COVID-19 will have higher inflammatory markers and distinct stroke imaging patterns compared with patients positive for COVID-19 with out-of-hospital stroke onset and milder or no COVID-19 symptoms. MATERIALS AND METHODS: This is a retrospective case series of patients positive for COVID-19 on polymerase chain reaction testing with imaging-confirmed stroke treated within a large health care network in New York City and Long Island between March 14 and April 26, 2020. Clinical and laboratory data collected retrospectively included complete blood counts and creatinine, alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer levels. All CT and MR imaging studies were independently reviewed by 2 neuroradiologists who recorded stroke subtype and patterns of infarction and intracranial hemorrhage. RESULTS: Compared with patients with COVID-19 with outside-of-hospital stroke onset and milder or no COVID-19 symptoms (n = 45, 52.3%), patients with stroke already hospitalized for severe COVID-19 (n = 41, 47.7%) had significantly more frequent infarctions (95.1% versus 73.3%, P = .006), with multivascular distributions (56.4% versus 33.3%, P = .022) and associated hemorrhage (31.7% versus 4.4%, P = .001). Patients with stroke admitted with more severe COVID-19 had significantly higher C-reactive protein and ferritin levels, elevated D-dimer levels, and more frequent lymphopenia and renal and hepatic injury (all, P < .003). CONCLUSIONS: Patients with stroke hospitalized with severe COVID-19 are characterized by higher inflammatory, coagulopathy, and tissue-damage biomarkers, supporting proposed pathogenic mechanisms of hyperinflammation activating a prothrombotic state. Cautious balancing of thrombosis and the risk of hemorrhagic transformation is warranted when considering anticoagulation.


Subject(s)
Biomarkers , COVID-19/complications , Stroke/complications , Adult , Aged , Aged, 80 and over , Blood Coagulation Disorders/etiology , COVID-19/diagnostic imaging , Cerebral Infarction/complications , Cerebral Infarction/diagnostic imaging , Female , Hospitalization , Humans , Liver Diseases/etiology , Lymphopenia/blood , Lymphopenia/etiology , Magnetic Resonance Imaging , Male , Middle Aged , Polymerase Chain Reaction , Retrospective Studies , Stroke/diagnostic imaging , Thrombosis/complications , Tomography, X-Ray Computed
7.
Stroke ; 51(9): e223-e226, 2020 09.
Article in English | MEDLINE | ID: covidwho-656606

ABSTRACT

BACKGROUND AND PURPOSE: Ischemic infarction of the corpus callosum is rare and infarction isolated to the corpus callosum alone rarer still, accounting for much <1% of ischemic stroke in most stroke registries. About half of callosal infarctions affect the splenium. METHODS: During a 2-week period, at the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City, 4 patients at Montefiore Medical Center in the Bronx were found to have ischemic lesions of the splenium of the corpus callosum, 2 with infarction isolated to the corpus callosum. RESULTS: All patients tested positive for COVID-19 and 3 had prolonged periods of intubation. All had cardiovascular risk factors. Clinically, all presented with encephalopathy and had evidence of coagulopathy and raised inflammatory markers. CONCLUSIONS: Infarction of the splenium of the corpus callosum is exceedingly rare and a cluster of such cases suggests COVID-19 as an inciting agent, with the mechanisms to be elucidated.


Subject(s)
Cerebral Infarction/complications , Cerebral Infarction/pathology , Coronavirus Infections/complications , Corpus Callosum/pathology , Pneumonia, Viral/complications , Aged , Aged, 80 and over , Brain Ischemia/complications , Brain Ischemia/pathology , COVID-19 , Diabetes Complications/complications , Fatal Outcome , Female , Humans , Hypertension/complications , Hypothyroidism/complications , Inflammation/blood , Intubation, Intratracheal , Middle Aged , Pandemics , Risk Factors , Stroke/etiology , Stroke/pathology , Stroke Rehabilitation
8.
Neurology ; 95(10): 454-457, 2020 09 08.
Article in English | MEDLINE | ID: covidwho-616669
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