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Concurrent Cardio-Cerebral Infarctions in COVID-19: A Systematic Review of Published Case Reports/Series
Rupak Desai1, Avilash Mondal2, Abhishek Prasad3
1Division of Cardiology, Atlanta VA Medical Center, Decatur, GA.
Insights
This study on 12 COVID-19 patients found that cerebrovascular events, including stroke, were common, often linked to risk factors like diabetes and hyperlipidemia. Many patients experienced neurological deficits post-discharge.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Background:
- COVID-19 infection has been associated with various neurological complications.
- Cerebrovascular events (CVEs) are a serious concern in patients with COVID-19.
- Understanding the specific patterns and risk factors for CVEs in COVID-19 patients is crucial.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of cerebrovascular events in patients with COVID-19.
- To identify common risk factors and neurological impairments associated with COVID-19 related CVEs.
- To analyze neuroimaging findings and treatment strategies in this patient cohort.
Main Methods:
- Retrospective study of 12 patients with confirmed or suspected COVID-19 and CVEs.
- Analysis of patient demographics, risk factors, clinical symptoms, and neuroimaging findings.
- Review of treatment modalities including conservative and interventional therapies, and patient outcomes.
Main Results:
- The majority of patients were male (83.3%) with a median age of 55. Common risk factors included Type 2 DM, hyperlipidemia, and smoking.
- Right-sided neurological and verbal impairments were most frequent. Left Middle Cerebral Artery (MCA) infarcts were observed in 58.3% of cases.
- Cerebral artery thrombosis, tandem occlusion, and stenosis were noted. Complications included left ventricular dysfunction and pulmonary embolism. 70% had residual deficits at discharge.
Conclusions:
- COVID-19 is associated with a significant burden of cerebrovascular events, particularly ischemic strokes.
- Prompt diagnosis and management, including antiplatelet therapy, anticoagulation, and revascularization procedures, are essential.
- Further research is needed to elucidate the mechanisms and optimize treatment for COVID-19 associated CVEs.
Abstract:
Twelve CCI patients were studied with confirmed or suspected COVID-19 infection. The majority of these patients were males (83.3%) with a median age of 55 years from three geographical locations, constituting the Middle East (7), Spain (3), and the USA (1). In 6 patients, IgG/IgM was positive for COVID-19, 4 with high pretest probability and 2 with positive RT-PCR. Type 2 DM, hyperlipidemia, and smoking were the primary risk factors. Right-sided neurological impairments and verbal impairment were the most common symptoms. Our analysis found 8 (66%) synchronous occurrences. In 58.3% of cases, neuroimaging showed left Middle Cerebral Artery (MCA) infarct and 33.3% right. Carotid artery thrombosis (16.6%), tandem occlusion (8.3%), and carotid stenosis (1%) were also reported in imaging. Dual antiplatelet therapy (DAPT) and anticoagulants were conservative therapies (10). Two AMI patients had aspiration thrombectomy, while three AIS patients had intravenous thrombolysis/tissue plasminogen activator (IVT-tPA), 2 had mechanical thrombectomy (MT), and 1 had decompressive craniotomy. Five had COVID-19-positive chest X-rays, whereas 4 were normal. four of 8 STEMI and 3 NSTEMI/UA patients complained chest pain. LV, ICA, and pulmonary embolism were further complications (2). Upon discharge, 7 patients (70%) had residual deficits while 1 patient unfortunately died.
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