Cerebrovascular Disease in Patients with COVID-19: A Review of the Literature and Case Series

• Published in: Case reports in neurology Vol. 12; no. 2; pp. 199 - 209
• Main Authors: Reddy, Sujan T., Garg, Tanu, Shah, Chintan, Nascimento, Fábio A., Imran, Rajeel, Kan, Peter, Bowry, Ritvij, Gonzales, Nicole, Barreto, Andrew, Kumar, Abhay, Volpi, John, Misra, Vivek, Chiu, David, Gadhia, Rajan, Savitz , Sean I.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.05.2020; Karger Publishers
• Subjects: Antibodies; Anticoagulants; apls; Case reports; Cerebrovascular disease; coronavirus; Coronaviruses; COVID-19; Cytokines; Etiology; Hemorrhage; Hypertension; Infections; Laboratories; Mortality; Pathophysiology; Patients; Pneumonia; Risk factors; sars-cov-2; Severe acute respiratory syndrome coronavirus 2; Single Case – General Neurology; Single Case − General Neurology; Stroke; Thrombosis; Viral infections; Viruses; China; COVID-19; APLS; Stroke; SARS-CoV-2; Coronavirus; Cerebrovascular disease
• ISSN: 1662-680X; 1662-680X
• DOI: 10.1159/000508958

COVID-19 has been associated with a hypercoagulable state causing cardiovascular and neurovascular complications. To further characterize cerebrovascular disease (CVD) in COVID-19, we review the current literature of published cases and additionally report the clinical presentation, laboratory and diagnostic testing results of 12 cases with COVID-19 infection and concurrent CVD from two academic medical centers in Houston, TX, USA, between March 1 and May 10, 2020. To date, there are 12 case studies reporting 47 cases of CVD in COVID-19. However, only 4 small case series have described the clinical and laboratory findings in patients with COVID-19 and concurrent stroke. Viral neurotropism, endothelial dysfunction, coagulopathy and inflammation are plausible proposed mechanisms of CVD in COVID-19 patients. In our case series of 12 patients, 10 patients had an ischemic stroke, of which 1 suffered hemorrhagic transformation and two had intracerebral hemorrhage. Etiology was determined to be embolic without a clear cause identified in 6 ischemic stroke patients, while the remaining had an identifiable source of stroke. The majority of the patients had elevated inflammatory markers such as D-dimer and interleukin-6. In patients with embolic stroke of unclear etiology, COVID-19 may have played a direct or indirect role in the processes that eventually led to the strokes while in the remaining cases, it is unclear if infection contributed partially or was an incidental finding.