scholarly journals COVID-19 and cerebrovascular diseases: a comprehensive overview

2020 ◽  
Vol 13 ◽  
pp. 175628642097800
Author(s):  
Georgios Tsivgoulis ◽  
Lina Palaiodimou ◽  
Ramin Zand ◽  
Vasileios Arsenios Lioutas ◽  
Christos Krogias ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Clinical Laboratory ◽  
Sinus Thrombosis ◽  
Case Reports ◽  
Cardiac Injury ◽  
Clinical Manifestations ◽  
Relevant Information ◽  
Cerebral Venous Sinus Thrombosis ◽  
Stroke Patients ◽  
Comprehensive Overview

Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.

scholarly journals CEREBROVASCULAR COMPLICATIONS OF COVID-19

2021 ◽  
Vol 9 (3) ◽  
Author(s):  
Volodymyr Lychko ◽  
Mykola Burtyka
Keyword(s):  
Cerebrovascular Disease ◽  
Clinical Laboratory ◽  
Sinus Thrombosis ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Relevant Information ◽  
Neurological Complications ◽  
Cerebral Venous Sinus Thrombosis ◽  
Systemic Review ◽  
Stroke Patients

The systematic online search of articles utilizing the search terms ”Coronavirus, SARS-COV-2 and Neurological complications”, published between January 2019 and September 2021, was performed. Neurological manifestations are prevalent during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is a clear association between cerebrovascular disease and coronavirus disease 2019 (COVID-19). But today, whether this association is causal or incidental is still unknown. This systemic review presents the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describes the most often neurological complications and their prognosis, discusses several clinical and laboratory characteristics. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune storm with inflammation, coagulopathy, complications due to critical illness and prolonged hospitalization can all contribute as potential etiological and pathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral haemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients, with a prevalence ranging between 0.5 % and 5.0 %. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients. Understanding of the specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ in recognizing COVID-19-related acute neurological complications.

Brain MRI-findings in Ph - negative myeloproliferative disorders

2019 ◽  
Vol 91 (7) ◽  
pp. 29-34 ◽  
Author(s):  
M M Tanashyan ◽  
A L Melikyan ◽  
P I Kuznetsova ◽  
A A Raskurazhev ◽  
A A Shabalina ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Sinus Thrombosis ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Myeloproliferative Disorders ◽  
Cerebral Venous Sinus Thrombosis ◽  
Mri Findings ◽  
Cerebral Lesions ◽  
Cerebrovascular Pathology ◽  
Underlying Mechanisms

Myeloproliferative disorders (MPD) are accompanied by a high proportion of thrombotic complications, which may lead to cerebrovascular disease (CVD). Aim. To describe MRI-findings in patients with Ph - negative MPD and evaluate any cerebrovascular disease. Materials and methods. We included 104 patients with Ph - negative MPD (age varied between 20 and 58) with clinical correlates of cerebrovascular pathology. Results. Brain MRI showed post - stroke lesions in 20% of patients (7 hemispheric infarcts due to thrombotic occlusion of one of the large cerebral arteries, 14 - cortical infarcts). 37 patients (36%) had vascular cerebral lesions. Cerebral venous sinus thrombosis occurred in 5 patients - in 7% (n=3) of patients with polycythemia vera and 5% (n=2) - in patients with essential thrombocythemia. The incidence of vascular cerebral lesions was associated with higher levels of the following: erythrocyte, platelet count, fibrinogen, and with the decrease in fibrinolytic activity, as well. Conclusion. The pioneering results of the study include the description and analysis of brain MRI-findings in patients with Ph - negative MPD. The underlying mechanisms of cerebrovascular pathology in these patients are associated with certain blood alterations (particularly, hemorheology) which present a major risk factor.

scholarly journals Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges

2021 ◽  
Vol 13 (4) ◽  
pp. 570-586
Author(s):  
Amber N. Edinoff ◽  
Sarah E. Kaufman ◽  
Janice W. Hollier ◽  
Celina G. Virgen ◽  
Christian A. Karam ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Case Reports ◽  
Cerebral Venous Sinus Thrombosis ◽  
Definitive Treatment ◽  
Gamma Aminobutyric Acid ◽  
Medical Conditions ◽  
Motor Pathways ◽  
Nmda Receptor Encephalitis ◽  
Excitatory Neurotransmission ◽  
Clinical Overview

Catatonia is a syndrome that has been associated with several mental illness disorders but that has also presented as a result of other medical conditions. Schizophrenia and other psychiatric disorders such as mania and depression are known to be associated with catatonia; however, several case reports have been published of certain medical conditions inducing catatonia, including hyponatremia, cerebral venous sinus thrombosis, and liver transplantation. Neuroleptic Malignant Syndrome and anti-NMDA receptor encephalitis are also prominent causes of catatonia. Patients taking benzodiazepines or clozapine are also at risk of developing catatonia following the withdrawal of these medications—it is speculated that the prolonged use of these medications increases gamma-aminobutyric acid (GABA) activity and that discontinuation may increase excitatory neurotransmission, leading to catatonia. The treatment of catatonia often involves the use of benzodiazepines, such as lorazepam, that can be used in combination therapy with antipsychotics. Definitive treatment may be found with electroconvulsive therapy (ECT). Aberrant neuronal activity in different motor pathways, defective neurotransmitter regulation, and impaired oligodendrocyte function have all been proposed as the pathophysiology behind catatonia. There are many clinical challenges that come with catatonia and, as early treatment is associated with better outcomes, it becomes imperative to understand these challenges. The purpose of this manuscript is to provide an overview of these challenges and to look at clinical studies regarding the pathophysiology, diagnosis, and treatment of as well as the complications and risk factors associated with catatonia.

Pulmonary involvements in systemic juvenile arthritis

2020 ◽  
Author(s):  
Tingyan He ◽  
Jiayun Ling ◽  
Jun Yang
Keyword(s):  
Sinus Thrombosis ◽  
Drug Hypersensitivity ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Clinical Manifestations ◽  
Cerebral Venous Sinus Thrombosis ◽  
Chronic Inflammatory Disease ◽  
Serum Cytokine ◽  
Radiological Features ◽  
Cytokine Levels ◽  
To Receive

Abstract Background Systemic juvenile idiopathic arthritis (sJIA) is a chronic inflammatory disease of childhood. Pulmonary involvements in sJIA have been recently described. Herein, we assess unusual clinical and radiological features of patients with sJIA, and possible risk factors for pulmonary involvements in sJIA. Methods A total of thirty-nine patients with sJIA were retrospectively enrolled. Data extracted included demographics, medical history, clinical manifestations, laboratory results, serum cytokine levels, radiological findings, management, and prognosis. Results Macrophage activation syndrome (MAS) had been observed at the initial diagnosis or during disease flares in eleven patients (11/39, 28%). Cerebral venous sinus thrombosis was observed in one patient with paroxysmal headache during the MAS phase. Twenty-three patients demonstrated abnormal radiological features on chest Computed Tomography (CT). Only eleven patients had subtle respiratory symptoms with normal oxygen saturation. Eight patients had lung disease (LD) before biologic exposure. sJIA-LD occurred in another six patients after the introduction of tocilizumab. All these patients continued to receive tocilizumab therapy, and sJIA-LD was improved in twelve patients with complete resolution of pulmonary presentations, and partially relieved in two patients. Only one of the two patients with possible anaphylaxis to tocilizumab presented with LD. Severe sJIA-LD was found in two patients with trisomy 21 and Kabuki syndrome, respectively. Conclusions Pulmonary involvements are increasingly observed in children with sJIA. Possible high risks for sJIA-LD include the occurrence of MAS, some inherited diseases, and evidence of drug hypersensitivity. It is still a question of whether IL-1/IL-6 inhibitor exposure increases the risk of sJIA-LD. Vasculitis and thrombosis should be considered in sJIA during the MAS phase, particularly in patients with pulmonary involvements. Trial registration: Not applicable; this was a retrospective study.

scholarly journals Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Alfonso J. Rodriguez-Morales ◽  
Jaime A. Cardona-Ospina ◽  
Estefanía Gutiérrez-Ocampo ◽  
Rhuvi Villamizar-Peña ◽  
Yeimer Holguin-Rivera ◽  
...  
Keyword(s):  
Observational Studies ◽  
Clinical Laboratory ◽  
Case Reports ◽  
Meta Analysis ◽  
Fatal Outcome ◽  
Clinical Manifestations ◽  
Clinical Infectious Disease ◽  
Imaging Features ◽  
Pooled Prevalence ◽  
Quantitative Analyses

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing a Public Health Emergency of International Concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of confirmed cases of COVID-19. All the observational studies, and also case reports, were included and analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Measures of heterogeneity were estimated and reported. Results: 660 articles were retrieved. After screening by abstract and title, 27 articles were selected for full-text assessment. Of them, 19 were finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent clinical manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), with 32.8% presenting acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) with a fatal outcome. Discussion: COVID-19 is a new clinical infectious disease, causing considerable compromise, especially in patients with comorbidities, requiring ICU in at least a fifth of them and sometimes with fatal outcomes. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

scholarly journals Cerebral Venous Sinus Thrombosis Associated with COVID-19: A Case Series and Literature Review

2020 ◽  
Author(s):  
Vahid Reza Ostovan ◽  
Razieh Foroughi ◽  
Mahtab Rostami ◽  
Mostafa Almasi-Dooghaee ◽  
Manouchehr Esmaili ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Hemorrhagic Transformation ◽  
Venous Sinus ◽  
Teaching Hospitals ◽  
Venous Sinus Thrombosis ◽  
North West ◽  
Confirmatory Tests

Abstract Background: Since the COVID-19 pandemic, several cases of cerebral venous sinus thrombosis (CVST) have been reported in SARS-CoV-2 infected individuals. This study provides a series of patients with CVST and SARS-CoV-2 infection.Methods: Consecutive patients with documented SARS-CoV-2 infection, as well as clinical and radiological characteristics of CVST, were reported from three teaching hospitals in the South West, North West, and the center of Iran from June to July 2020. We also searched the abstract archives until the end of August 2020 and gathered 28 reported cases. The diagnostic criteria for SARS-CoV-2 infection were determined according to SARS-CoV-2 detection in oropharyngeal or nasopharyngeal samples in clinically suspected patients. Demographics, main COVID-19 symptoms, confirmatory tests for SARS-CoV-2 infection diagnosis, the interval between the diagnosis of SARS-CoV-2 infection and CVST, clinical and radiological features of CVST, therapeutic strategies, CVST outcomes, rate of hemorrhagic transformation, and mortality rate were investigated.Results: Six patients (aged 31 to 62 years old) with confirmed CVST and SARS-CoV-2 infection were admitted to our centers. Four patients had no respiratory symptoms of SARS-CoV-2 infection. Five out of six patients developed the clinical manifestations of CVST and SARS-CoV-2 infection simultaneously. Three patients had known predisposing factors for CVST. Despite receiving CVST and SARS-CoV-2 infection treatments, four out of six patients passed away.Conclusions: The role of SARS-CoV-2 as a “cause” versus an “additive contributor” remains to be elucidated. Practitioners should be aware of the possibility of CVST in SARS-CoV-2 infection.

scholarly journals Prothrombotic immune thrombocytopenia after COVID-19 vaccine

Blood ◽  
2021 ◽  
Author(s):  
Andreas Tiede ◽  
Ulrich J Sachs ◽  
Andreas Czwalinna ◽  
Sonja Werwitzke ◽  
Rolf Bikker ◽  
...  
Keyword(s):  
Healthy Donor ◽  
Immune Thrombocytopenia ◽  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Cerebral Venous Sinus Thrombosis ◽  
Dependent Manner ◽  
Thromboembolic Events ◽  
Platelet Factor ◽  
Vein Thrombosis ◽  
Heparin Anticoagulation

We report five cases of prothrombotic immune thrombocytopenia after exposure to the ChAdOx1 vaccine (AZD1222, Vaxzevria) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients presented 5 to 11 days after first vaccination. The spectrum of clinical manifestations included cerebral venous sinus thrombosis (CVST), splanchnic vein thrombosis (SVT), arterial cerebral thromboembolism, and thrombotic microangiopathy (TMA). All patients had thrombocytopenia and markedly elevated D-Dimer. Autoantibodies against platelet factor 4 (PF4) were detected in all patients although they had never been exposed to heparin. Immunoglobulin from patient sera bound to healthy donor platelets in an AZD1222-dependant manner, suppressed by heparin. Aggregation of healthy donor platelets by patient sera was demonstrated in the presence of buffer or AZD1222 and was also suppressed by heparin. Anticoagulation alone or in combination with eculizumab or intravenous immunoglobulin (IVIG) resolved the pathology in three patients. Two patients had thromboembolic events despite anticoagulation at a time when platelets were increasing after IVIG. In summary, an unexpected autoimmune prothrombotic disorder is described after vaccination with AZD1222. It is characterized by thrombocytopenia and anti-PF4 antibodies binding to platelets in AZD1222-dependent manner. Initial clinical experience suggests a risk of unusual and severe thromboembolic events.

Cerebrovascular disease

2016 ◽  
Author(s):  
Sathiji Nageshwaran ◽  
Heather C Wilson ◽  
Anthony Dickenson ◽  
David Ledingham
Keyword(s):  
Cerebrovascular Disease ◽  
Carotid Artery Disease ◽  
Sinus Thrombosis ◽  
Vertebral Artery Dissection ◽  
Cerebral Venous Sinus Thrombosis ◽  
Artery Dissection ◽  
Risk Factor Modification ◽  
Symptomatic Carotid ◽  
Transient Ischaemic Attacks ◽  
Artery Disease

This chapter on cerebrovascular disease discusses the evidence-based management of acute stroke, transient ischaemic attacks (TIAs), and secondary stroke prevention (antiplatelet therapy, risk factor modification, atrial fibrillation (AF), carotid and vertebral artery dissection, and symptomatic carotid artery disease). Drug treatment of intracerebral haemorrhage, subarachnoid haemorrhage, and cerebral venous sinus thrombosis are also discussed.

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