scholarly journals 2019 novel coronavirus disease with secondary ischemic stroke: two case reports

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bin Fu ◽  
Yun Chen ◽  
Ping Li
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Laboratory ◽  
Case Reports ◽  
Small Vessel ◽  
Vessel Occlusion ◽  
Aged Patients ◽  
Health Crisis ◽  
Physical Examinations ◽  
Novel Coronavirus

Abstract Background The COVID-19 pandemic, which broke out in Wuhan in 2019, has become the global health crisis of our time. Elderly patients with certain fundamental diseases are more likely to develop severe cases. The secondary lesion following viral infection have only rarely been reported. Case presentation We here report two cases of coronavirus-infected pneumonia with acute ischemic stroke in middle-aged patients. In both COVID-19 cases, neurological physical examinations showed normal results before infection. Lymphocytopenia, accompanied by elevated cytokines and D-dimers, were found from serum clinical laboratory examination at admission. Dysarthria and limb muscle weakness are initial manifestations, occurring one week after infect-causative pathogen, SARS-CoV-2. The head CT and head/neck arterial CTA showed small-vessel occlusion. The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke. They were treated with tirofiban and followed up with daily aspirin and atorvastatin. Conclusions These cases suggested that secondary ischemic stroke, mainly manifested as small-vessel occlusion, should be considered for COVID-19 patients and diagnosed and treated promptly.

scholarly journals The 2019 novel coronavirus disease with secondary ischemic stroke: two cases report

2020 ◽  
Author(s):  
Bin Fu ◽  
Yun Chen ◽  
Ping Li
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Respiratory Illness ◽  
Small Vessel ◽  
Vessel Occlusion ◽  
Secondary Lesion ◽  
Novel Coronavirus ◽  
Underlying Diseases

Abstract Background : The 2019 novel coronavirus disease is an outbreak of respiratory illness first detected in Wuhan, China in the end of Dec, 2019. The older patients complicated with underlying diseases are reported more likely to have clinical symptoms. But its secondary lesion is rarely reported. Case presentation : We reported two cases of coronavirus infected pneumonia with acute ischemic stroke in patients at their middle-age. In both 2019 coronavirus diseases cases, neurological physical examination are normal before infection. Lymphocytopenia and high expression of cytokines and D-dimer were found from serum clinical laboratory test at admission. The tongue palsy, dysarthria and limb muscle weakness are initial manifestations in one week after 2019 novel coronavirus infection. The head CT and head/neck arterial CTA showed small-vessel occlusion. The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke. They were treated with tirofiban and followed up with daily aspirin and atorvastatin. Conclusion : The present cases suggest that secondary ischemic stroke, which mainly manifested as small-vessel occlusion, should be considered for coronavirus disease patients with prompt diagnosis and treatment.

scholarly journals The 2019 novel coronavirus disease with secondary ischemic stroke: two cases report

2020 ◽  
Author(s):  
Bin Fu ◽  
Yun Chen ◽  
Ping Li
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Respiratory Illness ◽  
Small Vessel ◽  
Vessel Occlusion ◽  
Secondary Lesion ◽  
Novel Coronavirus ◽  
Underlying Diseases

Abstract Background: The 2019 novel coronavirus disease is an outbreak of respiratory illness first detected in Wuhan, China in the end of Dec, 2019. The older patients complicated with underlying diseases are reported more likely to have clinical symptoms. But its secondary lesion is rarely reported. Case presentation: We reported two cases of coronavirus infected pneumonia with acute ischemic stroke in patients at their middle-age. In both 2019 coronavirus diseases cases, neurological physical examination are normal before infection. Lymphocytopenia and high expression of cytokines and D-dimer were found from serum clinical laboratory test at admission. The dysarthria and limb muscle weakness are initial manifestations in one week after 2019 novel coronavirus infection. The head CT and head/neck arterial CTA showed small-vessel occlusion. The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke. They were treated with tirofiban and followed up with daily aspirin and atorvastatin. Conclusion: The present cases suggested that secondary ischemic stroke, which mainly manifested as small-vessel occlusion, should be considered for coronavirus disease patients with prompt diagnosis and treatment.

scholarly journals Dabigatran Reversal Before Intravenous Tenecteplase in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1616-1619 ◽  
Author(s):  
James Beharry ◽  
Michael J. Waters ◽  
Roy Drew ◽  
John N. Fink ◽  
Duncan Wilson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scale Score ◽  
Clinical Laboratory ◽  
Intravenous Thrombolysis ◽  
Interquartile Range ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Background and Purpose— Reversal of dabigatran before intravenous thrombolysis in patients with acute ischemic stroke has been well described using alteplase but experience with intravenous tenecteplase is limited. Tenecteplase seems at least noninferior to alteplase in patients with intracranial large vessel occlusion. We report on the experience of dabigatran reversal before tenecteplase thrombolysis for acute ischemic stroke. Methods— We included consecutive patients with ischemic stroke receiving dabigatran prestroke treated with intravenous tenecteplase after receiving idarucizumab. Patients were from 2 centers in New Zealand and Australia. We reported the clinical, laboratory, and radiological characteristics and their functional outcome. Results— We identified 13 patients receiving intravenous tenecteplase after dabigatran reversal. Nine (69%) were male, median age was 79 (interquartile range, 69–85) and median baseline National Institutes of Health Stroke Scale score was 6 (interquartile range, 4–21). Atrial fibrillation was the indication for dabigatran therapy in all patients. All patients had a prolonged thrombin clotting time (median, 80 seconds [interquartile range, 57–113]). Seven patients with large vessel occlusion were referred for endovascular thrombectomy, 2 of these patients (29%) had early recanalization with tenecteplase abrogating thrombectomy. No patients had parenchymal hemorrhage or symptomatic hemorrhagic transformation. Favorable functional outcome (modified Rankin Scale score, 0–2) occurred in 8 (62%) patients. Two deaths occurred from large territory infarction. Conclusions— Our experience suggests intravenous thrombolysis with tenecteplase following dabigatran reversal using idarucizumab may be safe in selected patients with acute ischemic stroke. Further studies are required to more precisely estimate the efficacy and risk of clinically significant hemorrhage.

scholarly journals Effect of Edaravone on Neurological Symptoms in Real-World Patients With Acute Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1805-1811 ◽  
Author(s):  
Susumu Kobayashi ◽  
Shingo Fukuma ◽  
Tatsuyoshi Ikenoue ◽  
Shunichi Fukuhara ◽  
Shotai Kobayashi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Symptoms ◽  
Small Vessel ◽  
Large Artery ◽  
Stroke Subtype ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Ischemic Stroke Subtype ◽  
History Of

Background and Purpose— In Japan, nearly half of ischemic stroke patients receive edaravone for acute treatment. The purpose of this study was to assess the effect of edaravone on neurological symptoms in patients with ischemic stroke stratified by stroke subtype. Methods— Study subjects were 61 048 patients aged 18 years or older who were hospitalized ≤14 days after onset of an acute ischemic stroke and were registered in the Japan Stroke Data Bank, a hospital-based multicenter stroke registration database, between June 2001 and July 2013. Patients were stratified according to ischemic stroke subtype (large-artery atherosclerosis, cardioembolism, small-vessel occlusion, and cryptogenic/undetermined) and then divided into 2 groups (edaravone-treated and no edaravone). Neurological symptoms were evaluated using the National Institutes of Health Stroke Scale (NIHSS). The primary outcome was changed in neurological symptoms during the hospital stay (ΔNIHSS=NIHSS score at discharge−NIHSS score at admission). Data were analyzed using multivariate linear regression with inverse probability of treatment weighting after adjusting for the following confounding factors: age, gender, and systolic and diastolic blood pressure at the start of treatment, NIHSS score at admission, time from stroke onset to hospital admission, infarct size, comorbidities, concomitant medication, clinical department, history of smoking, alcohol consumption, and history of stroke. Results— After adjusting for potential confounders, the improvement in NIHSS score from admission to discharge was greater in the edaravone-treated group than in the no edaravone group for all ischemic stroke subtypes (mean [95% CI] difference in ΔNIHSS: −0.46 [−0.75 to −0.16] for large-artery atherosclerosis, −0.64 [−1.09 to −0.2] for cardioembolism, and −0.25 [−0.4 to −0.09] for small-vessel occlusion). Conclusions— For any ischemic stroke subtype, edaravone use (compared with no use) was associated with a greater improvement in neurological symptoms, although the difference was small (<1 point NIHSS) and of limited clinical significance.

scholarly journals Intra-arterial thrombolysis for acute ischemic stroke: Our institutional experience

2012 ◽  
Vol 01 (01) ◽  
pp. 038-040
Author(s):  
R.V. Narayana ◽  
Rajesh Pati ◽  
Sibasankar Dalai
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Reports ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Multicentric Study ◽  
Feasible Option ◽  
Institutional Experience ◽  
Arterial Thrombolysis

Abstract The standard treatment for acute ischemic stroke is intravenous (IV) rtPA for patients who can reach the hospital within 3 to 4.5 h. There are case reports, where IA thrombolysis has helped patients in case an IV thrombolysis has failed. We report 14 cases of acute ischemic stroke treated by intra-arterial (IA) thrombolysis. We have retrospectively analyzed 14 cases of acute ischemic stroke treated at our department between December 2008 and October 2011 by intra-arterial thrombolysis. The patients with suspected large vessel occlusion (11 patients) and patients not responding to IV rtPA (3 patients) were considered for the IA thrombolysis. We achieved complete recanalization (TIMI 3) in 11 patients. One patient had a bleed following the procedure but recovered well during the hospital stay. All the patients were followed up to 90 days. Majority of them have good functional outcome. Our study suggests that intra-arterial thrombolysis is a feasible option in the subgroup of patients with large vessel occlusion. However, there is a need for a randomized multicentric study to support our results.

scholarly journals A review on covid-19 and acute ischemic stroke, malignant cerebral edema & decompressive hemicraniectomy: A perfect storm; tackling this crisis by understanding it

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Ardavan Ahmadvand ◽  
◽  
Hamidreza Seifmanesh ◽  
Maryam Ghandali ◽  
Ali Afrasiabi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Edema ◽  
Neurological Complication ◽  
Healthcare Providers ◽  
Neurological Complications ◽  
Current Data ◽  
Vessel Occlusion ◽  
Decompressive Hemicraniectomy ◽  
Novel Coronavirus

Since the world was hit by novel coronavirus pandemic, so many challenges for all healthcare providers have been arisen. It is safe to say that no specialty was singled out in the matter of different complication from this viscous covid-19 situation and neurologists and neurosurgeon were no different. There are some studied reporting neurological complication associated with coronavirus infections but when it comes to life threatening and acute neurological complications such as strokes and malignant cerebral edema the data is scant. Here we are going to review the possible pathophysiology of this phenomenon, the relationship between covid-19 and acute ischemic stroke and malignant cerebral edema by taking a closer look at current data regarding this matter. Keywords: covid-19; acute ischemic stroke; malignant cerebral edema; covid-19 associated neurological complications. Abbreviations: DHC: Decompressive Hemicraniectomy; ELVO: Emergent Large Vessel Occlusion; MCE: Malignant Cerebral Edema.

scholarly journals Intravenous Thrombolysis for Acute Ischemic Stroke: Review of 97 Patients

2017 ◽  
Vol 08 (01) ◽  
pp. 038-043 ◽  
Author(s):  
Anish Mehta ◽  
Rohan Mahale ◽  
Kiran Buddaraju ◽  
Anas Majeed ◽  
Suryanarayana Sharma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Intravenous Thrombolysis ◽  
Favorable Outcome ◽  
Small Vessel ◽  
Stroke Severity ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Poor Outcome

ABSTRACT Background: Intravenous thrombolysis (IVT) has now become a standard treatment in eligible patients with acute ischemic stroke (AIS) who present within 4.5 h of symptom onset. Objective: To determine the usefulness of IVT and the subset of patients who will benefit from IVT in AIS within 4.5 h. Materials and Methods: Patients with AIS within 4.5 h of symptom onset who underwent IVT were studied prospectively. The study period was from October 2011 to October 2015. Results: A total of 97 patients were thrombolysed intravenously. The mean onset to needle time in all patients was 177.2 ± 62 min (range: 60–360). At 3 months follow-up, favorable outcome was seen in 65 patients (67.1%) and poor outcome including death in the remaining 32 patients (32.9%). Factors predicting favorable outcome was age <65 years (P = 0.02), the National Institute of Health Stroke Scale (NIHSS) <15 (P < 0.001), small vessel occlusion (P = 0.006), cardioembolism (P = 0.006), and random blood sugar (RBS) <250 mg/dl (P < 0.001). Factors predicting poor outcome was diabetes mellitus (P = 0.01), dyslipidemia (P = 0.01), NIHSS at admission >15 (P = 0.03), RBS >250 mg/dl (P = 0.01), Dense cerebral artery sign, age, glucose level on admission, onset-to-treatment time, NIHSS on admission score >5 (P = 0.03), and occlusion of large artery (P = 0.02). Conclusion: Milder baseline stroke severity, blood glucose <250 mg/dL, younger patients (<65 years), cardioembolic stroke, and small vessel occlusion benefit from recombinant tissue plasminogen activator.

Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients

2020 ◽  
Vol 132 (4) ◽  
pp. 1182-1187 ◽  
Author(s):  
Carrie E. Andrews ◽  
Nikolaos Mouchtouris ◽  
Evan M. Fitchett ◽  
Fadi Al Saiegh ◽  
Michael J. Lang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Multivariate Logistic Regression Analysis ◽  
Standard Of Care ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Younger Patients ◽  
Success Of Treatment

OBJECTIVEMechanical thrombectomy (MT) is now the standard of care for acute ischemic stroke (AIS) secondary to large-vessel occlusion, but there remains a question of whether elderly patients benefit from this procedure to the same degree as the younger populations enrolled in the seminal trials on MT. The authors compared outcomes after MT of patients 80–89 and ≥ 90 years old with AIS to those of younger patients.METHODSThe authors retrospectively analyzed records of patients undergoing MT at their institution to examine stroke severity, comorbid conditions, medical management, recanalization results, and clinical outcomes. Univariate and multivariate logistic regression analysis were used to compare patients < 80 years, 80–89 years, and ≥ 90 years old.RESULTSAll groups had similar rates of comorbid disease and tissue plasminogen activator (tPA) administration, and stroke severity did not differ significantly between groups. Elderly patients had equivalent recanalization outcomes, with similar rates of readmission, 30-day mortality, and hospital-associated complications. These patients were more likely to have poor clinical outcome on discharge, as defined by a modified Rankin Scale (mRS) score of 3–6, but this difference was not significant when controlled for stroke severity, tPA administration, and recanalization results.CONCLUSIONSOctogenarians, nonagenarians, and centenarians with AIS have similar rates of mortality, hospital readmission, and hospital-associated complications as younger patients after MT. Elderly patients also have the capacity to achieve good functional outcome after MT, but this potential is moderated by stroke severity and success of treatment.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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