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Large and Small Cerebral Vessel Involvement in Severe COVID-19: Detailed Clinical Workup of a Case Series.
Keller, Emanuela; Brandi, Giovanna; Winklhofer, Sebastian; Imbach, Lukas L; Kirschenbaum, Daniel; Frontzek, Karl; Steiger, Peter; Dietler, Sabeth; Haeberlin, Marcellina; Willms, Jan; Porta, Francesca; Waeckerlin, Adrian; Huber, Michael; Abela, Irene A; Lutterotti, Andreas; Stippich, Christoph; Globas, Christoph; Varga, Zsuzsanna; Jelcic, Ilijas.
  • Keller E; Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine (E.K.), University Hospital and University of Zurich, Switzerland.
  • Brandi G; Institute of Intensive Care Medicine (G.B., P.S., S.D., J.W.), University Hospital and University of Zurich, Switzerland.
  • Winklhofer S; Department of Neuroradiology (S.W., C.S.), University Hospital and University of Zurich, Switzerland.
  • Imbach LL; Department of Neurology (L.L.I., M. Haeberlin), University Hospital and University of Zurich, Switzerland.
  • Kirschenbaum D; Department of Neuropathology (D.K., K.F.), University Hospital and University of Zurich, Switzerland.
  • Frontzek K; Department of Neuropathology (D.K., K.F.), University Hospital and University of Zurich, Switzerland.
  • Steiger P; Institute of Intensive Care Medicine (G.B., P.S., S.D., J.W.), University Hospital and University of Zurich, Switzerland.
  • Dietler S; Institute of Intensive Care Medicine (G.B., P.S., S.D., J.W.), University Hospital and University of Zurich, Switzerland.
  • Haeberlin M; Department of Neurology (L.L.I., M. Haeberlin), University Hospital and University of Zurich, Switzerland.
  • Willms J; Institute of Intensive Care Medicine (G.B., P.S., S.D., J.W.), University Hospital and University of Zurich, Switzerland.
  • Porta F; Intensive Care Unit, Graubuenden Cantonal Hospital, Chur, Switzerland (F.P., A.W.).
  • Waeckerlin A; Intensive Care Unit, Graubuenden Cantonal Hospital, Chur, Switzerland (F.P., A.W.).
  • Huber M; Institute of Medical Virology, University of Zurich, Switzerland (M. Huber).
  • Abela IA; Department of Infectious Diseases and Hospital Epidemiology (I.A.A.), University Hospital and University of Zurich, Switzerland.
  • Lutterotti A; Neuroimmunology and Multiple Sclerosis Research Section (A.L., I.J.), University Hospital and University of Zurich, Switzerland.
  • Stippich C; Department of Neuroradiology (S.W., C.S.), University Hospital and University of Zurich, Switzerland.
  • Globas C; Stroke Unit, Department of Neurology (C.G.), University Hospital and University of Zurich, Switzerland.
  • Varga Z; Department of Pathology and Molecular Pathology (Z.V.), University Hospital and University of Zurich, Switzerland.
  • Jelcic I; Neuroimmunology and Multiple Sclerosis Research Section (A.L., I.J.), University Hospital and University of Zurich, Switzerland.
Stroke ; 51(12): 3719-3722, 2020 12.
Article in English | MEDLINE | ID: covidwho-1050419
ABSTRACT
BACKGROUND AND

PURPOSE:

Case series indicating cerebrovascular disorders in coronavirus disease 2019 (COVID-19) have been published. Comprehensive workups, including clinical characteristics, laboratory, electroencephalography, neuroimaging, and cerebrospinal fluid findings, are needed to understand the mechanisms.

METHODS:

We evaluated 32 consecutive critically ill patients with COVID-19 treated at a tertiary care center from March 9 to April 3, 2020, for concomitant severe central nervous system involvement. Patients identified underwent computed tomography, magnetic resonance imaging, electroencephalography, cerebrospinal fluid analysis, and autopsy in case of death.

RESULTS:

Of 32 critically ill patients with COVID-19, 8 (25%) had severe central nervous system involvement. Two presented with lacunar ischemic stroke in the early phase and 6 with prolonged impaired consciousness after termination of analgosedation. In all but one with delayed wake-up, neuroimaging or autopsy showed multiple cerebral microbleeds, in 3 with additional subarachnoid hemorrhage and in 2 with additional small ischemic lesions. In 3 patients, intracranial vessel wall sequence magnetic resonance imaging was performed for the first time to our knowledge. All showed contrast enhancement of vessel walls in large cerebral arteries, suggesting vascular wall pathologies with an inflammatory component. Reverse transcription-polymerase chain reactions for SARS-CoV-2 in cerebrospinal fluid were all negative. No intrathecal SARS-CoV-2-specific IgG synthesis was detectable.

CONCLUSIONS:

Different mechanisms of cerebrovascular disorders might be involved in COVID-19. Acute ischemic stroke might occur early. In a later phase, microinfarctions and vessel wall contrast enhancement occur, indicating small and large cerebral vessels involvement. Central nervous system disorders associated with COVID-19 may lead to long-term disabilities. Mechanisms should be urgently investigated to develop neuroprotective strategies.
Subject(s)
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cerebral Arteries / Cerebral Hemorrhage / Cerebrovascular Disorders / Ischemic Stroke / COVID-19 Type of study: Diagnostic study / Experimental Studies / Prognostic study Topics: Long Covid Country/Region as subject: Europa Language: English Journal: Stroke Year: 2020 Document Type: Article Affiliation country: STROKEAHA.120.031224

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cerebral Arteries / Cerebral Hemorrhage / Cerebrovascular Disorders / Ischemic Stroke / COVID-19 Type of study: Diagnostic study / Experimental Studies / Prognostic study Topics: Long Covid Country/Region as subject: Europa Language: English Journal: Stroke Year: 2020 Document Type: Article Affiliation country: STROKEAHA.120.031224