Hemorrhagic Posterior Reversible Encephalopathy Syndrome: A Rare Neurological Complication of COVID-19 Infection

Neurological complications of COVID-19 are well documented. However, there are limited reports of posterior reversible encephalopathy syndrome (PRES) associated with COVID-19 in the literature. Herein, we described a 21-year-old man with a history of bipolar disease and opioid addiction who was admitted because of COVID-19 infection. He suddenly experienced a convulsive status epilepticus following hypertension crisis. The patient was intubated and underwent antiepileptic and anti-hypertensive therapy. His brain imaging was compatible with PRES. The patient gradually improved and was eventually discharged after 40 days. On the next month follow-up, the patient was able to walk with a cane without a history of seizure. In this report, we aimed to highlight the less common cerebrovascular complication of COVID-19 infection.

Korelasi antara Stroke dengan Covid-19

The clinical spectrum of Covid-19 is very broad, ranging from minor no specific symptom, such as fever, dry cough and diarrhea, some time combined with mild pneumonia and mild dyspnoe to severe pneumonia with dyspnoe, tachypnoe and exchange disorders, leading to severe pulmonary dysfunction, necessary ventilation, shock and multiple organ failure. Preliminary unpublished evidence suggest that patient with covid-19 have an increased risk of acute ischemic stroke. Neurologic complaints that oven occurs are headache, dizziness, change in taste and smell. Five percent risk of developing acute ischemic stroke. Coronavirus has a tendency to invade the central nerve system (CNS). The olfactory change that have been seen in covid-19, are attributed to reflex access from the virus to the brain via the transcribial route, although this remain to be proven for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). One report from China showed that neurological complaint, such as dizziness, headaches, hypgeusia and hyposmia, were common (about 36%) in covid-19 patients. Encephalopathy and altered mental status also occurs in patients who have been infected with the SARS-CoV-2 virus. Cerebrovascular disease is more common in severe covid-19; acute ischemic stroke has been reported to occurs in 5.7% of patients and impaired consciousness in 15% of patients, and 1% cerebral hemorrhage was found. CNS disorders that require surgery require special treatment because of the effect of techniques and anesthetics on the CNS, as wll as the protection of health professionals to preventdiseses transmission. Thirty-eight percents of covid-19 patient with cerebrovascular complication died.

Cerebrovascular Complication and Valve Surgery in Infective Endocarditis

Infective endocarditis (IE) with neurologic complications is common in patients with active IE. The most common and feared neurological complication of left-sided IE is cerebrovascular, from septic emboli causing ischemic stroke, intracranial hemorrhage (ICH), or an infectious intracranial aneurysm with or without rupture. In patients with cerebrovascular complications, valve replacement surgery is often delayed for concern of further neurological worsening. However, in circumstances when an indication for valve surgery to treat IE is present, the benefits of early surgical treatment may outweigh the potential neurologic deterioration. Furthermore, valve surgery has been associated with lower in-hospital mortality than medical therapy with intravenous antibiotics alone. Early valve surgery can be performed within 7 days of transient ischemic attack or asymptomatic stroke when medically indicated. Timing of valve surgery for IE after symptomatic medium or large symptomatic ischemic stroke or ICH remains challenging, and current data in the literature are conflicting about the risks and benefits. A delay of 2 to 4 weeks from the time of the cerebrovascular event is often recommended, balancing the risks and benefits of surgery. The range of timing of valve surgery varies depending on the clinical scenario, and is best determined by a multidisciplinary decision between cardiothoracic surgeons, cardiologists, infectious disease experts, and vascular neurologists in an experienced referral center.

Mechanical thrombectomy in acute ischemic stroke patients under venoarterial extracorporeal membrane oxygenation

BackgroundUse of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adult patients to treat refractory cardiogenic shock has increased in recent years, and ischemic stroke is the most frequent VA-ECMO-induced cerebrovascular complication. No adult case of mechanical thrombectomy (MT) has been reported.MethodsRetrospective observational study of hospital medical records of patients who received circulatory support with VA-ECMO with acute ischemic stroke treated with MT, from 2006 to 2018.ResultsTwo adult patients on VA-ECMO with acute ischemic stroke treated with MT were found. Both cases were successfully treated.ConclusionThese cases illustrate the feasibility of performing MT in adult patients on ECMO.

A Case of Mitral Valve Endocarditis Complicated by Multiple Embolic Phenomena: Leaping from Adult Guidelines to Pediatric Critical Care Decisions

Early surgical intervention for children with infective endocarditis (IE) and cerebrovascular sequelae has significant risks, resulting in practice variation amongst pediatric cardiologists, intensivists, and cardiothoracic surgeons. The limited pediatric consensus recommendations make decision making for practitioners challenging. The added risk of multiorgan dysfunction syndrome can make these decisions even more difficult. We present the case of a 14-year-old with IE and resultant multiorgan dysfunction syndrome including cerebrovascular complication, successfully treated by primary valve repair within the 1st week of diagnosis.

Complications of Diagnostic Cardiac Catheterization in National Heart Centre, Nepal

Cardiac Catheterization for diagnostic has been routinely used for the last few years in national heart centre in Nepal. Complications have been recognized as an important factor in morbidity and mortality after diagnostic catheterization. Improvements of technique and technology have reduced the morbidity of routine diagnostic catheterization, but occasional mortality seems to be unavoidable. A total of 6074 consecutive diagnostic cardiac diagnostic cardiac catheterization performed in Shahid Gangalal National Heart Centre, Kathmandu, Nepal between 2004 to 2008 were evaluated for their complications. Among them 4584 (75.46%) were coronary angiogram. 894 (14.71%) were right heart study and 596 (9.81%) were left heart study. There were 5 deaths (0.09%). Four deaths occurred following coronary angiogram and I death following left heart study in a 3 years old boy with Tetralogy of Fallot. Vascular complications occurred in 20(0.33% patients) with groin haematoma in 8 (0.13%), pseudoaneurysm in 5 (0.09%), arterrio venous fistula in 3 (0.05%) and femoral artery thrombosis in 4 (0.06%) patients. Contrast allergy occurred in 7(0.12%), cerebrovascular complication in 3 (0.05%), vasovagal reaction in 5 (0.09%) and pyrogen reaction in 10 (0.16%) of patients. The diagnostic cardiac catheterization in national heart centre has acceptable low rate of complication which includes death.