Cerebrovascular complications in patients with SARS-CoV-2 infection: Case series

Abstract

Abstract Background: Italy is one of the most affected countries by the Coronavirus disease 2019 (COVID-19). The responsible pathogen is named Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2). The clinical spectrum ranges from asymptomatic infection to severe pneumonia leading to intensive care unit admission. Evidence of cerebrovascular complications associated with SARS-CoV-2 is limited. We herein report 6 patients who developed acute stroke during COVID-19 infection. Methods: Retrospective case series of patients diagnosed with COVID-19 using reverse-transcriptase–polymerase-chain-reaction (RT-PCR) on nasopharyngeal swabs, who developed clinical and neuroimaging evidence of acute stroke during SARS-CoV-2 infection. Results : Six patients were identified (5 men); median age was 69 years (range: 57-82). Stroke subtypes were ischemic (4, 67%) and hemorrhagic (2, 33%). All patients but 1 had pre-existing vascular risk factors. One patient developed encephalopathy prior to stroke, characterized by focal seizures and behavioral abnormalities. COVID-19-related pneumonia was severe (i.e. requiring critical care support) in 5/6 cases (83%). Liver enzyme alteration and lactate dehydrogenase (LDH) elevation was registered in all cases. Four patients (67%) manifested acute kidney failure prior to stroke. Four patients (67%) had abnormal coagulation tests. Outcome was poor in the majority of the patients: 4 died (67%), 1 is still in coma (20%) and the remaining 1 remains severely neurologically affected (mRS: 4). Conclusions : Acute stroke can complicate the course of COVI-19 infection. In our series, stroke developed mostly in patients with severe pneumonia and multi organ failure, liver enzymes and LDH were markedly increased in all cases, and the outcome was poor.