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Cerebrovascular Involvement in Mucormycosis in COVID-19 Pandemic.
Kulkarni, Rahul; Pujari, Shripad S; Gupta, Dulari; Ojha, Pawan; Dhamne, Megha; Bolegave, Vyankatesh; Dhonde, Pramod; Soni, Anand; Adwani, Sikandar; Diwan, Anand; Duberkar, Dhananjay; Batra, Dhruv; Deshpande, Rushikesh; Aurangabadkar, Kaustubh; Palasdeokar, Nilesh.
  • Kulkarni R; Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, India. Electronic address: rahulneuro@gmail.com.
  • Pujari SS; Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Noble Hospital, Pune, India.
  • Gupta D; Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
  • Ojha P; Department of Neurology, Grant Medical College and Sir JJ Hospital, Mumbai, India.
  • Dhamne M; Department of Neurology, Dr L H Hiranandani Hospital, Mumbai, India.
  • Bolegave V; Department of Neurology, RGMC and CSM Hospital, Thane, India.
  • Dhonde P; Dhonde Hospital, Nanded, India.
  • Soni A; United Ciigma Hospital, Aurangabad, India.
  • Adwani S; Department of Neurology, Radiant Superspeciality Hospital, Amravati, India.
  • Diwan A; Department of Neurology, Narayani Hospital, Nashik, India.
  • Duberkar D; Department of Neurology, Sahyadri Hospital, Nashik, India.
  • Batra D; Department of Neurology, Viveka Hospitals Pvt Ltd, Nagpur, India.
  • Deshpande R; Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
  • Aurangabadkar K; Diamond Superspeciality Hospital, Kolhapur, Pune.
  • Palasdeokar N; Department of Neurology, Noble hospital, Ruby Hall Clinic, Wanowarie, Pune, India.
J Stroke Cerebrovasc Dis ; 31(2): 106231, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1525871
ABSTRACT

BACKGROUND:

Many countries have seen an unprecedented rise of cases of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM). Cerebrovascular involvement in CAM has not been studied so far. We describe clinico-radiological manifestations of cerebrovascular complications observed in CAM.

METHODS:

In this multicentric retrospective observational study from India, patients with CAM who developed cerebrovascular involvement were studied. Their demographics, risk factors, clinical manifestations, imaging, laboratory profile and outcomes were noted.

RESULTS:

Out of 49 subjects with cerebrovascular involvement, 71.4% were males while average age was 52.9 years. Ischemic stroke was commonest (91.8%) followed by intracranial haemorrhage (6.1%) and subarachnoid haemorrhage (2%). The incidence of cerebrovascular complications in CAM was found to be 11.8% in one center. Cerebrovascular symptoms appeared a median of 8.3 days from the onset of mucormycosis. Commonest presentation of mucormycosis was rhino-orbito-cerebral syndrome in 98%. Diabetes mellitus was present in 81.7%. Forty percent developed stroke despite being on antiplatelet agent and/or heparin. Amongst subjects with ischemic strokes, location of stroke was unilateral anterior circulation (62.2%); bilateral anterior circulation (17.8%); posterior circulation (11.1%) and combined anterior and posterior circulation (8.9%). Vascular imaging revealed intracranial occlusion in 62.1%; extracranial occlusion in 3.4% and normal vessels in 34.5%. Mortality was 51% during hospital stay.

CONCLUSIONS:

Cerebrovascular involvement was seen in 11.8% patients of CAM. Angio-invasive nature of the fungus, prothrombotic state created by COVID-19, and diabetes were important causative factors. Subjects with CAM should be screened for involvement of the brain as well as its vessel. Antiplatelet agents/heparin did not seem to provide complete protection from this type of stroke.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cerebrovascular Disorders / SARS-CoV-2 / COVID-19 / Mucormycosis Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cerebrovascular Disorders / SARS-CoV-2 / COVID-19 / Mucormycosis Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2022 Document Type: Article