Cerebral Herniation Secondary to Stroke-associated Hemorrhagic Transformation, Fulminant Cerebral Edema in Setting of COVID-19 Associated ARDS and Active Malignancy
We present the case of a very rapid neurologic and radiographic decline of a patient with an acute ischemic stroke who developed rapid fulminant cerebral edema leading to herniation in the setting of hypercarbic respiratory failure attributed to SARS-CoV-2 infection.
SUMMARY: Since December 2019, a novel Severe Acute Respiratory Syndrome coronavirus 2 from China has rapidly spread worldwide. Although respiratory involvement is the mainstay of coronavirus disease 2019 (COVID-19), systemic involvement has recently drawn more attention. In particular, a number of recent articles have shed light on the nervous system as one of the possible targets. At our institution, we observed 15 patients with acute brain vascular manifestations; most interesting, we had a higher prevalence of the posterior circulation acute impairment. In our series, 7 patients had acute posterior cerebral injury: 1, h...
Angelo Gemignani The Coronavirus Disease 2019 (COVID-19) outbreak has shocked the whole world with its unexpected rapid spread. The virus responsible for the disease, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), enters host cells by means of the envelope spike protein, which binds to angiotensin-converting enzyme 2 receptors. These receptors are highly expressed in heart, lungs, respiratory tract epithelium, endothelial cells and brain. Since an increasing body of significant evidence is highlighting a possible neuroinvasion related to SARS-CoV-2, a state of the art on the neurological complication...
Coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), usually presents as a respiratory illness. Neurological manifestations can be seen in 36.4% of patients.1 Patients with vascular risk factors (VRFs), including history of stroke, tend to have worse prognosis.2 COVID-19 triggers a robust inflammatory response which leads to hypercoagulability and thromboembolism.3 Reports of stroke in patients with COVID-19 are mostly limited to small case series or case reports of ischemic stroke (IS), though intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) have also been reported.
AbstractObjectivesThe OVID study will demonstrate whether prophylactic-dose enoxaparin improves survival and reduces hospitalizations in symptomatic ambulatory patients aged 50 or older diagnosed with COVID-19, a novel viral disease characterized by severe systemic, pulmonary, and vessel inflammation and coagulation activation.Trial designThe OVID study is conducted as a multicentre open-label superiority randomised controlled trial.ParticipantsInclusion Criteria1. Signed patient informed consent after being fully informed about the study ’s background.2. Patients aged 50 years or older with a positive test for SARS-...
We report a unique neurologic complication of COVID-19 in a patient who had extensive cerebral small-vessel ischemic lesions resembling cerebral vasculitis in a characteristic combined imaging pattern of ischemia, hemorrhage, and punctuate postcontrast enhancement. Also, a characteristic lower extremity skin rash was present in our patient. Our observation lends support to the increasingly suspected mechanism of "endotheliitis" associated with this novel coronavirus.
ConclusionsIt is feasible to perform PDT on intubated COVID-19 patients using the AerosolVE negative-pressure tent. This is a promising low-cost device to decrease risk to healthcare providers during AGPs.
ConclusionsThe COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.
Covid-19 has significant implications of hematologic systems, including lymphocytopenia, thrombocytopenia, ischemic or hemorrhagic stroke, pulmonary thromboembolism, and myocardial infarction [1,2]. Iwasaki et al. reported that the pathogen of Covid-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can induce immune dysfunction, inflammation, and antibody-dependent enhancement by activating host cells via the Fc γIIa receptor in the same way as SARS-CoV-1 .
CONCLUSIONS: Considering the possibility of neurological involvement in patients with SARS-CoV-2 infection can result in earlier diagnosis and treatment; otherwise permanent, irreversible sequelae and even death may follow. More comprehensive studies may indicate that until the end of the present pandemic, young adults with unexplained and unexpected stroke as well as patients with newly diagnosed Guillain-Barré syndrome should be tested for SARS-CoV-2 infection. PMID: 32698732 [PubMed - as supplied by publisher]
An increasing body of evidence suggests that the coronavirus disease 2019 (SARS-CoV2) may be associated with cerebrovascular disease, although most cases have been ischemic strokes related to occlusion of major intracranial vessels [1 –3]. Intracranial hemorrhages in the setting of SARS-CoV2 infection are exceedingly rare. To the best of our knowledge, only two cases has been reported in detail, one with a massive parenchymal brain hemorrhage and the other with an aneurysmal subarachnoid hemorrhage [4,5].