Large and Small Cerebral Vessel Involvement in Severe COVID-19: Detailed Clinical Workup of a Case Series.
Large and Small Cerebral Vessel Involvement in Severe COVID-19: Detailed Clinical Workup of a Case Series.
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DOI：
10.1161/strokeaha.120.031224
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发表时间：
2020-12
期刊：
影响因子：
8.3
通讯作者：
Jelcic I
中科院分区：
文献类型：
--
作者：
Keller E;Brandi G;Winklhofer S;Imbach LL;Kirschenbaum D;Frontzek K;Steiger P;Dietler S;Haeberlin M;Willms J;Porta F;Waeckerlin A;Huber M;Abela IA;Lutterotti A;Stippich C;Globas C;Varga Z;Jelcic I
补充数字内容可在文本中找到。2019冠状病毒病（COVID-19）中显示脑血管疾病的病例系列已发表。需要进行全面的检查，包括临床特征、实验室检查、脑电图、神经影像学和脑脊液检查结果，以了解其机制。我们评估了2020年3月9日至4月3日期间在三级医疗中心接受治疗的32名连续重症COVID-19患者的伴随严重中枢神经系统受累。对确定的患者进行计算机断层扫描、磁共振成像、脑电图、脑脊液分析，并在死亡的情况下进行尸检。在32名COVID-19重症患者中，8名（25%）有严重的中枢神经系统受累。2例在早期出现腔隙性缺血性卒中，6例在镇痛镇静剂终止后出现长期意识障碍。除1例延迟唤醒外，所有患者的神经影像学或尸检均显示多发性脑微出血，3例伴有额外的蛛网膜下腔出血，2例伴有额外的小缺血性病变。其中3例首次行颅内血管壁序列磁共振成像。所有患者均显示大脑动脉血管壁造影增强，提示血管壁病变伴炎症成分。脑脊液SARS-CoV-2逆转录聚合酶链反应均为阴性。鞘内未检测到SARS-CoV-2特异性IgG合成。COVID-19可能涉及脑血管疾病的不同机制。急性缺血性卒中可能发生在早期。在后期，微梗死和血管壁对比增强发生，表明小和大的脑血管参与。与COVID-19相关的中枢神经系统疾病可能导致长期残疾。应迫切研究其机制，以制定神经保护策略。
Supplemental Digital Content is available in the text. Case series indicating cerebrovascular disorders in coronavirus disease 2019 (COVID-19) have been published. Comprehensive workups, including clinical characteristics, laboratory, electroencephalography, neuroimaging, and cerebrospinal fluid findings, are needed to understand the mechanisms. We evaluated 32 consecutive critically ill patients with COVID-19 treated at a tertiary care center from March 9 to April 3, 2020, for concomitant severe central nervous system involvement. Patients identified underwent computed tomography, magnetic resonance imaging, electroencephalography, cerebrospinal fluid analysis, and autopsy in case of death. Of 32 critically ill patients with COVID-19, 8 (25%) had severe central nervous system involvement. Two presented with lacunar ischemic stroke in the early phase and 6 with prolonged impaired consciousness after termination of analgosedation. In all but one with delayed wake-up, neuroimaging or autopsy showed multiple cerebral microbleeds, in 3 with additional subarachnoid hemorrhage and in 2 with additional small ischemic lesions. In 3 patients, intracranial vessel wall sequence magnetic resonance imaging was performed for the first time to our knowledge. All showed contrast enhancement of vessel walls in large cerebral arteries, suggesting vascular wall pathologies with an inflammatory component. Reverse transcription-polymerase chain reactions for SARS-CoV-2 in cerebrospinal fluid were all negative. No intrathecal SARS-CoV-2-specific IgG synthesis was detectable. Different mechanisms of cerebrovascular disorders might be involved in COVID-19. Acute ischemic stroke might occur early. In a later phase, microinfarctions and vessel wall contrast enhancement occur, indicating small and large cerebral vessels involvement. Central nervous system disorders associated with COVID-19 may lead to long-term disabilities. Mechanisms should be urgently investigated to develop neuroprotective strategies.