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 |
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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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