Elsevier

Journal of Clinical Neuroscience

Volume 79, September 2020, Pages 60-66
Journal of Clinical Neuroscience

Clinical study
Arterial and venous strokes in the setting of COVID-19

https://doi.org/10.1016/j.jocn.2020.07.005Get rights and content

Highlights

  • COVID-19 is a global pandemic that has overwhelmed health care systems around the world.

  • SARS-CoV-2 can affect both the central and peripheral nervous systems.

  • Arterial and venous ischemic strokes can occur in COVID-19 patients.

  • Strokes in COVID-19 patients can occur while on therapeutic dose of anticoagulation.

  • Elevated D-dimer and inflammatory markers are a possible cause of strokes in COVID-19 patients.

Abstract

Background and purpose

Coronavirus disease 2019 (COVID-19) is a global pandemic that causes flu-like symptoms. There is a growing body of evidence suggesting that both the central and peripheral nervous systems can be affected by SARS-CoV-2, including stroke. We present three cases of arterial ischemic strokes and one venous infarction from a cerebral venous sinus thrombosis in the setting of COVID-19 infection who otherwise had low risk factors for stroke.

Methods

We retrospectively reviewed patients presenting to a large tertiary care academic US hospital with stroke and who tested positive for COVID-19. Medical records were reviewed for demographics, imaging results and lab findings.

Results

There were 3 cases of arterial ischemic strokes and 1 case of venous stroke: 3 males and 1 female. The mean age was 55 (48–70) years. All arterial strokes presented with large vessel occlusions and had mechanical thrombectomy performed. Two cases presented with stroke despite being on full anticoagulation.

Conclusions

It is important to recognize the neurological manifestations of COVID-19, especially ischemic stroke, either arterial or venous in nature. Hypercoagulability and the cytokine surge are perhaps the cause of ischemic stroke in these patients. Further studies are needed to understand the role of anticoagulation in these patients.

Keywords

COVID-19
SARS-CoV-2
Stroke
Cerebral venous thrombosis

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