Bihemispheric ischemic strokes in patients with COVID-19
BACKGROUND: There is emerging evidence that COVID-19 can trigger thrombosis because of a hypercoagulable state, including large-vessel occlusion ischemic strokes. Bihemispheric ischemic stroke is uncommon and is thought to indicate an embolic source. Here, we examine the findings and outcomes of pat...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Brain Circulation |
| Subjects: | |
| Online Access: | http://www.braincirculation.org/article.asp?issn=2394-8108;year=2022;volume=8;issue=1;spage=10;epage=16;aulast=Kurian |
| _version_ | 1828733415013220352 |
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| author | ChristeenaKurian StephanMayer GurmeenKaur RamandeepSahni EricFeldstein MenaSamaan DivyaViswanathan TamarahSami Syed Faizan Ali HusseinAl-Shammari JessicaBloomfield MichelleBravo RollaNuoman EdwinGulko Chirag D Gandhi FawazAl-Mufti |
| author_facet | ChristeenaKurian StephanMayer GurmeenKaur RamandeepSahni EricFeldstein MenaSamaan DivyaViswanathan TamarahSami Syed Faizan Ali HusseinAl-Shammari JessicaBloomfield MichelleBravo RollaNuoman EdwinGulko Chirag D Gandhi FawazAl-Mufti |
| author_sort | ChristeenaKurian |
| collection | DOAJ |
| description | BACKGROUND: There is emerging evidence that COVID-19 can trigger thrombosis because of a hypercoagulable state, including large-vessel occlusion ischemic strokes. Bihemispheric ischemic stroke is uncommon and is thought to indicate an embolic source. Here, we examine the findings and outcomes of patients with bihemispheric stroke in the setting of COVID-19.
METHODS: We performed a retrospective cohort study at a quaternary academic medical center between March 1, 2020, and April 30, 2020. We identified all patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who presented with simultaneous bihemispheric ischemic strokes.
RESULTS: Of 637 COVID-19 admissions during the 2-month period, 13 had a diagnosis of acute ischemic stroke, including 5 who developed bihemispheric cerebral infarction. Three of those 5 (60%) were female, median age was 54 (range 41–67), and all five were being managed for severe COVID-19-related pneumonia complicated by acute kidney injury and liver failure before the diagnosis of cerebral infarction was established. Five presented with elevated ferritin, lactate dehydrogenase, and interleukin-6 (IL-6) levels, and four had lymphopenia and elevated D-dimer levels. All patients underwent neuroimaging with computed tomography for persistent depressed mentation, with or without a focal neurologic deficit, demonstrating multifocal ischemic strokes with bihemispheric involvement. Outcome was poor in all patients: two were discharged to a rehabilitation facility with moderate-to-severe disability and three (60%) patients died.
CONCLUSIONS: Stroke is implicated in SARS-CoV-2 infection. Although causality cannot be established, we present the imaging and clinical findings of patients with COVID-19 and simultaneous bihemispheric ischemic strokes. Multifocal ischemic strokes with bihemispheric involvement should be considered in COVID-19 patients with severe infection and poor neurologic status and may be associated with poor outcomes. |
| first_indexed | 2024-04-12T22:29:30Z |
| format | Article |
| id | doaj.art-6abd5ed1a3d848378fe5ce2a909c5153 |
| institution | Directory Open Access Journal |
| issn | 2455-4626 |
| language | English |
| last_indexed | 2024-04-12T22:29:30Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Brain Circulation |
| spelling | doaj.art-6abd5ed1a3d848378fe5ce2a909c51532022-12-22T03:14:01ZengWolters Kluwer Medknow PublicationsBrain Circulation2455-46262022-01-0181101610.4103/bc.bc_65_21Bihemispheric ischemic strokes in patients with COVID-19ChristeenaKurianStephanMayerGurmeenKaurRamandeepSahniEricFeldsteinMenaSamaanDivyaViswanathanTamarahSamiSyed Faizan AliHusseinAl-ShammariJessicaBloomfieldMichelleBravoRollaNuomanEdwinGulkoChirag D GandhiFawazAl-MuftiBACKGROUND: There is emerging evidence that COVID-19 can trigger thrombosis because of a hypercoagulable state, including large-vessel occlusion ischemic strokes. Bihemispheric ischemic stroke is uncommon and is thought to indicate an embolic source. Here, we examine the findings and outcomes of patients with bihemispheric stroke in the setting of COVID-19. METHODS: We performed a retrospective cohort study at a quaternary academic medical center between March 1, 2020, and April 30, 2020. We identified all patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who presented with simultaneous bihemispheric ischemic strokes. RESULTS: Of 637 COVID-19 admissions during the 2-month period, 13 had a diagnosis of acute ischemic stroke, including 5 who developed bihemispheric cerebral infarction. Three of those 5 (60%) were female, median age was 54 (range 41–67), and all five were being managed for severe COVID-19-related pneumonia complicated by acute kidney injury and liver failure before the diagnosis of cerebral infarction was established. Five presented with elevated ferritin, lactate dehydrogenase, and interleukin-6 (IL-6) levels, and four had lymphopenia and elevated D-dimer levels. All patients underwent neuroimaging with computed tomography for persistent depressed mentation, with or without a focal neurologic deficit, demonstrating multifocal ischemic strokes with bihemispheric involvement. Outcome was poor in all patients: two were discharged to a rehabilitation facility with moderate-to-severe disability and three (60%) patients died. CONCLUSIONS: Stroke is implicated in SARS-CoV-2 infection. Although causality cannot be established, we present the imaging and clinical findings of patients with COVID-19 and simultaneous bihemispheric ischemic strokes. Multifocal ischemic strokes with bihemispheric involvement should be considered in COVID-19 patients with severe infection and poor neurologic status and may be associated with poor outcomes.http://www.braincirculation.org/article.asp?issn=2394-8108;year=2022;volume=8;issue=1;spage=10;epage=16;aulast=Kuriancoronavirus disease 2019embolismischemic strokeneurologic complicationssevere acute respiratory syndrome coronavirus 2 |
| spellingShingle | ChristeenaKurian StephanMayer GurmeenKaur RamandeepSahni EricFeldstein MenaSamaan DivyaViswanathan TamarahSami Syed Faizan Ali HusseinAl-Shammari JessicaBloomfield MichelleBravo RollaNuoman EdwinGulko Chirag D Gandhi FawazAl-Mufti Bihemispheric ischemic strokes in patients with COVID-19 Brain Circulation coronavirus disease 2019 embolism ischemic stroke neurologic complications severe acute respiratory syndrome coronavirus 2 |
| title | Bihemispheric ischemic strokes in patients with COVID-19 |
| title_full | Bihemispheric ischemic strokes in patients with COVID-19 |
| title_fullStr | Bihemispheric ischemic strokes in patients with COVID-19 |
| title_full_unstemmed | Bihemispheric ischemic strokes in patients with COVID-19 |
| title_short | Bihemispheric ischemic strokes in patients with COVID-19 |
| title_sort | bihemispheric ischemic strokes in patients with covid 19 |
| topic | coronavirus disease 2019 embolism ischemic stroke neurologic complications severe acute respiratory syndrome coronavirus 2 |
| url | http://www.braincirculation.org/article.asp?issn=2394-8108;year=2022;volume=8;issue=1;spage=10;epage=16;aulast=Kurian |
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