Stroke in patients with SARS-CoV-2 infection: case series
Stroke in patients with SARS-CoV-2 infection: case series
复制标题
DOI：
10.1007/s00415-020-09885-2
复制
发表时间：
2020-05-20
影响因子：
6
通讯作者：
Vogrig, Alberto
中科院分区：
文献类型：
--
作者：
Morassi, Mauro;Bagatto, Daniele;Vogrig, Alberto
背景意大利是受冠状病毒病2019年(新冠肺炎)影响最严重的国家之一。负责病原体被命名为严重急性呼吸综合征冠状病毒(SARS-CoV-2)。临床范围从无症状感染到严重肺炎，导致重症监护病房入院。与SARS-CoV-2相关的脑血管并发症的证据有限。我们在此报告六名在新冠肺炎感染期间发生急性卒中的患者。方法对经鼻咽拭子逆转录聚合酶链式反应诊断为新冠肺炎的患者进行回顾性研究，这些患者在SARS-CoV-2感染期间有急性卒中的临床和神经影像证据。结果确诊患者6例(男性5例)，中位年龄69岁(57-82岁)。卒中亚型有缺血性(4例，67%)和出血性(2例，33%)。除一名患者外，所有患者都有先前存在的血管危险因素。一名患者在中风前出现脑病，特征是局灶性癫痫发作和行为异常。5/6例(83%)新冠肺炎相关肺炎病情严重(即需要重症监护支持)。所有病例均有肝酶改变和乳酸脱氢酶(LDH)升高。4名患者(67%)在中风前表现为急性肾功能衰竭。4例(67%)凝血试验异常。大多数患者的结果很差：5例死亡(83%)，其余1例(17%)仍受到严重的神经影响(MRS：4)。结论缺血性和出血性卒中均可使Covi-19感染的病程复杂化。本组病例卒中多发于重症肺炎合并多器官功能衰竭患者，肝酶及LDH均明显升高，预后较差。
Background Italy is one of the most affected countries by the coronavirus disease 2019 (COVID-19). The responsible pathogen is named severe acute respiratory syndrome coronavirus (SARS-CoV-2). The clinical spectrum ranges from asymptomatic infection to severe pneumonia, leading to intensive care unit admission. Evidence of cerebrovascular complications associated with SARS-CoV-2 is limited. We herein report six patients who developed acute stroke during COVID-19 infection. Methods A retrospective case series of patients diagnosed with COVID-19 using reverse-transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs, who developed clinical and neuroimaging evidence of acute stroke during SARS-CoV-2 infection. Results Six patients were identified (5 men); median age was 69 years (range 57-82). Stroke subtypes were ischemic (4, 67%) and hemorrhagic (2, 33%). All patients but one had pre-existing vascular risk factors. One patient developed encephalopathy prior to stroke, characterized by focal seizures and behavioral abnormalities. COVID-19-related pneumonia was severe (i.e., requiring critical care support) in 5/6 cases (83%). Liver enzyme alteration and lactate dehydrogenase (LDH) elevation were registered in all cases. Four patients (67%) manifested acute kidney failure prior to stroke. Four patients (67%) had abnormal coagulation tests. The outcome was poor in the majority of the patients: five died (83%) and the remaining one (17%) remained severely neurologically affected (mRS: 4). Conclusions Both ischemic and hemorrhagic stroke can complicate the course of COVI-19 infection. In our series, stroke developed mostly in patients with severe pneumonia and multiorgan failure, liver enzymes and LDH were markedly increased in all cases, and the outcome was poor.