Malignant Cerebral Ischemia in A COVID-19 Infected Patient: Case Review and Histopathological Findings

Autor: Xianyuan Song, Mohammad Khaled, Patrick Troy, Augusto Parra, Mubashir Pervez, Smit Patel, Ryan Kollar
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Pathology
thromboembolic conditions
vasculitis
Brain Ischemia
0302 clinical medicine
Risk Factors
hemorrhagic stroke
Myocardial infarction
anticoagulation
Stroke
cerebral sinus thrombosis
Ischemic stroke
medicine.diagnostic_test
Rehabilitation
thrombotic conditions
Middle Aged
Thrombosis
SARS-CoV-2 RNA
cerebrovascular disease
Treatment Outcome
Host-Pathogen Interactions
Disease Progression
medicine.symptom
Coronavirus Infections
Vasculitis
Cardiology and Cardiovascular Medicine
Inflammatory conditions
medicine.medical_specialty
Corona virus
Pneumonia
Viral
Ischemia
Clinical Neurology
Inflammation
Article
Betacoronavirus
03 medical and health sciences
Thromboembolism
medicine
Coagulopathy
Humans
Pandemics
SARS-CoV-2
business.industry
Brain biopsy
COVID-19
medicine.disease
Surgery
Neurology (clinical)
business
030217 neurology & neurosurgery
Zdroj: Journal of Stroke and Cerebrovascular Diseases
ISSN: 1532-8511
1052-3057
Popis: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is responsible for an unprecedented worldwide pandemic that has severely impacted the United States. As the pandemic continues, a growing body of evidence suggests that infected patients may develop significant coagulopathy with resultant thromboembolic complications including deep vein thrombosis, pulmonary embolism, myocardial infarction, and ischemic stroke. However, this data is limited and comes from recent small case series and observational studies on stroke types, mechanisms, and outcomes.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 Furthermore, evidence on the role of therapeutic anticoagulation in SARS-CoV-2 infected patients with elevated inflammatory markers, such as D-dimer, is also limited. We report the case of a middle-aged patient who presented with a large vessel ischemic stroke likely resulting from an underlying inflammatory response in the setting of known novel coronavirus infection (COVID-19). Histopathologic analysis of the patient's ischemic brain tissue revealed hypoxic neurons and significant edema from the underlying ischemic insult, fibrin thrombi in small vessels, and fibroid necrosis of the vascular wall without any signs of vasculature inflammation. Brain biopsy was negative for the presence of SARS-CoV-2 RNA (RT-PCR assay). Along with a growing body of literature, our case suggests that cerebrovascular thromboembolic events in COVID-19 infection may be related to acquired hypercoagulability and coagulation cascade activation due to the release of inflammatory markers and cytokines, rather than virus-induced vasculitis. Further studies to investigate the mechanism of cerebrovascular thromboembolic events and their prevention is warranted.
Databáze: OpenAIRE
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