COVID-19 and stroke: from the cases to the causes

Abstract During COVID-19 pandemic, a wide variety of stroke typologies have been described in patients affected by SARS-CoV-2. Investigating the case reports of acute stroke in COVID-19 patients, published since the beginning of the pandemic, we tried to trace the pathogenic mechanisms of stroke during SARS-CoV-2 infection. We conducted a systematic review analyzing demographic data, cerebrovascular risk factors, NIHSS score, vascular territory involvement and laboratory findings of 168 patients described in 89 studies, from a pool of 1243 records. Based on our results, we have identified different stroke profiles: (1) cerebral large vessel disease (CLVD) profile with a low disability, simultaneous onset of COVID-19 and stroke symptoms, good outcome and low serum levels of D-dimer and CRP; (2) intracranial bleeding (IB) profile with high disability, poor outcome and low levels of serum markers of inflammation and coagulopathy; (3) CLVD profile with a short time-lapse between COVID-19 symptoms and stroke onset, high neurological disability and very high systemic inflammatory markers; (4) multiple thrombo-embolic disease (MTED) profile with older patients, many comorbidities, disabling stroke, poor outcome, evident alteration of coagulation tests and high serum levels of both D-dimer and CRP. We therefore summarized these different profiles in a spectrum similar to that of visible light, where the violet–blue band included IB and CSVD with low inflammation and prothrombotic activity, the green–yellow band included CLVD with high inflammation and moderate prothrombotic activity and the orange–red band for MTED with moderate-high levels of inflammation and very high prothrombotic activity.

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Thrombin antithrombin complex and IL-18 serum levels in stroke patients

Neurology International ◽

10.4081/ni.2010.e1 ◽

2010 ◽

Vol 2 (1) ◽

pp. 1 ◽

Cited By ~ 6

Author(s):

Ornella Piazza ◽

Giuliana Scarpati ◽

Simona Cotena ◽

Maria Lonardo ◽

Rosalba Tufano

Keyword(s):

Antithrombin Iii ◽

Degradation Products ◽

Focal Cerebral Ischemia ◽

Serum Levels ◽

High Serum ◽

Fibrin Degradation Products ◽

Markers Of Inflammation ◽

Complex Picture ◽

Thrombin Antithrombin Iii Complex ◽

D Dimer

The complex picture of inflammation and coagulation alterations comes to life in acute stroke phases. Increasing evidence points to a strong interaction and extensive crosstalk between the inflammation and coagulation systems: the interest towards this relationship has increased since recent experimental research showed that the early administration of antithrombin III (ATIII) decreases the volume of ischemia in mice and might be neuroprotective, playing an antiinflammatory role. We aimed to establish the extent of the relationship among markers of inflammation (S100B and IL-18) and procoagulant and fibrinolytic markers (ATIII, thrombin-antithrombin III complex (TAT), Fibrin Degradation Products (FDP), D-dimer) in 13 comatose patients affected by focal cerebral ischemia. Plasma levels of TAT, D-dimer and FDP, IL18 and S100B were increased. IL-18 and S100B high serum levels in ischemic patients suggest an early activation of the inflammatory cascade in acute ischemic injury. The basic principles of the interaction between inflammatory and coagulation systems are revised, from the perspective that simultaneous modulation of both coagulation and inflammation, rather than specific therapies aimed at one of these systems could be more successful in stroke therapy.

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Syndrome of Reduced Sensitivity to Thyroid Hormones: Two Case Reports and a Literature Review

Case Reports in Endocrinology ◽

10.1155/2016/7546453 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Anastasios Anyfantakis ◽

Dimitrios Anyfantakis ◽

Irene Vourliotaki

Keyword(s):

Thyroid Hormone ◽

Multinodular Goiter ◽

Target Genes ◽

Case Reports ◽

Serum Levels ◽

Free T4 ◽

Laboratory Findings ◽

Toxic Multinodular Goiter ◽

High Doses ◽

Primary Hyperthyroidism

Resistance to thyroid hormone (RTH) is an extremely rare dominantly inherited condition of impaired tissue responsiveness to thyroid hormone (TH). Most patients with RTH have mutations in the gene that encodes theβisoform of the receptor of thyroid hormone (THR-βgene). Mutant receptors are unable to activate or repress target genes. The majority of them are asymptomatic or rarely have hypo- or hyperthyroidism. RTH is suspected by the finding of persistent elevation of serum levels of free T3 (FT3) and free T4 (FT4) and nonsuppressed TSH. We present two cases of RTH diagnosed after total thyroidectomy. The first patient was initially diagnosed with primary hyperthyroidism due to toxic multinodular goiter. The second patient had undergone thyroidectomy for multinodular goiter 16 years before diagnosis of RTH. After thyroidectomy, although on relatively high doses of levothyroxine, both of them presented with the laboratory findings of RTH. Genetic analysis revealed RTH.

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Two Patients with Extremely Elevated Tumor Markers: Where Is the Malignancy?

Gastroenterology Research and Practice ◽

10.1155/2011/123743 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

Patrick P. J. van der Veek ◽

Wouter H. de Vos tot Nederveen Cappel ◽

Alexandra M. J. Langers ◽

Bart van Hoek

Keyword(s):

Tumor Markers ◽

Malignant Disease ◽

Elevated Serum ◽

Serum Levels ◽

Stone Disease ◽

High Serum ◽

Response To Treatment ◽

Serum Tumor Markers ◽

Painless Jaundice ◽

Very High

Serum tumor markers are useful to evaluate a cancer's response to treatment, for early detection of cancer relapse, and, in some cases, to diagnose malignancy. In this paper, we present two patients with significantly elevated serum tumor markerswithoutevidence of malignant disease. An 18-year-old patient suffering from autoimmune hepatitis had markedly increased alpha-fetoprotein (aFP) levels (2,002 μg/L; normal <10 ug/L). Extensive imaging showed no signs of hepatocellular carcinoma or other cancer, and treatment with Prednisone led to rapid normalization of both liver enzymes and aFP. The second patient, a 60-year-old female with painless jaundice due to biliary stone disease, had very high serum levels of CA19-9 (18,000 kU/L, normal <27 kU/L). Liver biochemistry and serum CA19-9 concentration decreased to almost normal values (45 kU/L) after biliary stenting. These cases demonstrate that serum tumor markers can be elevated in benign disease and are therefore not appropriate to diagnose cancer.

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Pseudotumoral retroperitoneal fibrosis and localized vasculitis with very high serum levels of anti-PR3 ANCA

The American Journal of Medicine ◽

10.1016/s0002-9343(03)00284-5 ◽

2003 ◽

Vol 115 (3) ◽

pp. 250b-252 ◽

Cited By ~ 7

Author(s):

Elisabeth Aslangul ◽

Brigitte Ranque ◽

Thomas Papo

Keyword(s):

Retroperitoneal Fibrosis ◽

Serum Levels ◽

High Serum ◽

Very High

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Cerebrovascular comorbidity, high blood levels of C - reactive protein and D-dimer are associated with disease outcomes in COVID-19 patients

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-201002 ◽

2020 ◽

pp. 1-12

Author(s):

Foad Alzoughool ◽

Lo’ai Alanagreh ◽

Suhad Abumweis ◽

Manar Atoum

Keyword(s):

Case Reports ◽

Meta Analysis ◽

Serum Levels ◽

Blood Levels ◽

C Reactive Protein ◽

Reactive Protein ◽

Cerebrovascular Complications ◽

Increased Risk ◽

Risk Of Disease ◽

D Dimer

The emerging coronavirus disease (COVID-19) swept the world, affecting more than 200 countries and territories. As of August 22, 2020, the pandemic infected more than 23,329,752 including 807,054 patients who have died. Although the main clinical features of the pandemic disease are respiratory, cerebrovascular comorbidities emerged as one of the leading causes of death associated with COVID-19. Different case reports have indicated that C-reactive protein (CRP) and D-dimer (pro-inflammatory biomarkers) were elevated in COVID-19 patients, which can significantly increase the risk of ischemic stroke. Available data on cerebrovascular complications in COVID-19 patients were collected and a meta-analysis was designed and carried out to evaluate the risk of severity and mortality associated with high levels of CRP and D-dimer levels in COVID-19 patients. In addition, we aimed to describe the overall event rate of pre-existing cerebrovascular disease in COVID-19 patients. In our analysis, 5,614 cases have been studied, out of these patients 164 cases have developed cerebrovascular comorbities. Cerebrovascular comorbidity increased the risk of disease severity (odd ratio = 4.4; 95% CI: 1.48 to 12.84) and mortality (odd ratio = 7.0; 95% CI: 2.56 to 18.99). Statistical analyses showed that CRP and D-dimer serum levels were elevated by six-folds in the severe cases of COVID-19 patients. This significant increase in these two proteins levels can serve as a vital indicator for COVID-19 patients who are at increased risk of severe COVID-19 cerebrovascular complications, such as stroke.

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