Introduction: The 2019 Corona (Covid-19) disease is considered a potential extrinsic factor in the genesis or aggravation of a stroke. Patients with severe Covid-19 are more likely to develop stroke. Comment: We report three cases of stroke including one intracerebral haematoma and two cases of cerebral ischaemia revealing Covid-19. A history of hypertension was found in two of our patients, no notion of contagion was reported. Neurological signs were preceded by at least three days of infectious syndrome and respiratory distress syndrome. These were consistent and associated. Our patients all tested positive for Covid-19. They all had a positive CRP. Lung lesions of the alveolar, interstitial and alveolo-interstitial type were found on lung imaging. All our patients were treated with oxygen therapy, paracetamol, chloroquine and azythromicyne. In addition, acetylsalicylic acid for ischaemic strokes and nicardipine for haemorrhagic stroke. We have recorded two death and one recovery, the youngest (52 years old) with no cardiovascular risk factors. Neurological signs and symptoms can be attributed to neuroinvasion of the virus, and cerebral hypoxia. The diagnosis of Covid-19 is not a contraindication to endovascular treatment for a stroke. Stroke increase the death rate during Covid-19. Conclusion: Stroke is less frequent during Covid-19. Neurological signs are non-specific and combine respiratory and infectious signs. The treatment is multidisciplinary and has a variable prognosis.
References
[1]
Ai, T., Yang, Z., Hou, H., Zhan, C., Chen, C., Lv, W. et al. (2020). Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology,296, E32-E40. https://doi.org/10.1148/radiol.2020200642
[2]
Al Saiegh, F., Ghosh, R., Leibold, A., Avery, M. B., Schmidt, R. F., Theofanis, T. et al. (2020). Status of SARS-CoV-2 in Cerebrospinal Fluid of Patients with COVID-19 and Stroke. JournalofNeurology,Neurosurgery&Psychiatry,91, 846-848. https://doi.org/10.1136/jnnp-2020-323522
[3]
Beigel, J. H., Tomashek, K. M., Dodd, L. E., Mehta, A. K., Zingman, B. S., Kalil, A. C. et al. (2020). Remdesivir for the Treatment of Covid-19—Final Report. NewEnglandJournalofMedicine,383, 1813-1826. https://doi.org/10.1056/nejmoa2007764
[4]
Bersano, A., & Pantoni, L. (2020). On Being a Neurologist in Italy at the Time of the COVID-19 Outbreak. Neurology,94, 905-906. https://doi.org/10.1212/wnl.0000000000009508
[5]
Beyrouti, R., Adams, M. E., Benjamin, L., Cohen, H., Farmer, S. F., Goh, Y. Y. et al. (2020). Characteristics of Ischaemic Stroke Associated with Covid-19. JournalofNeurology,Neurosurgery&Psychiatry,91, 889-891. https://doi.org/10.1136/jnnp-2020-323586
[6]
Boccatonda, A., Campello, E., Simion, C., & Simioni, P. (2023). Long-Term Hypercoagulability, Endotheliopathy and Inflammation Following Acute SARS-CoV-2 Infection. ExpertReviewofHematology,16, 1035-1048. https://doi.org/10.1080/17474086.2023.2288154
[7]
Caruso, D., Zerunian, M., Polici, M., Pucciarelli, F., Polidori, T., Rucci, C. et al. (2020). Chest CT Features of COVID-19 in Rome, Italy. Radiology,296, E79-E85. https://doi.org/10.1148/radiol.2020201237
[8]
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y. et al. (2020). Epidemiological and Clinical Characteristics of 99 Cases of 2019 Novel Coronavirus Pneumonia in Wuhan, China: A Descriptive Study. TheLancet,395, 507-513. https://doi.org/10.1016/s0140-6736(20)30211-7
[9]
Consoli, D., Vidale, S., Aguglia, U., Bassi, P., Cavallini, A., Galati, F. et al. (2015). Previous Infection and the Risk of Ischaemic Stroke in Italy: The IN2 Study. EuropeanJournalofNeurology,22, 514-519. https://doi.org/10.1111/ene.12601
[10]
Elkind, M. S. (2007). Why Now? Moving from Stroke Risk Factors to Stroke Triggers. CurrentOpinioninNeurology,20, 51-57. https://doi.org/10.1097/wco.0b013e328012da75
[11]
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y. et al. (2020). Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. TheLancet,395, 497-506. https://doi.org/10.1016/s0140-6736(20)30183-5
[12]
Jin, H., Hong, C., Chen, S., Zhou, Y., Wang, Y., Mao, L. et al. (2020). Consensus for Prevention and Management of Coronavirus Disease 2019 (COVID-19) for Neurologists. StrokeandVascularNeurology,5, 146-151. https://doi.org/10.1136/svn-2020-000382
[13]
Lau, K. K., Yu, W. C., Chu, C. M. et al. (2004). Infection possible du système nerveux central par le coronavirus du SRAS. Maladiesinfectieusesémergentes,10, 342-344.
[14]
Li, Y., Wang, M., Zhou, Y., & Chang, J. (2020). Maladie cérébrovasculaire aiguë consécutive à la COVID-19: Étude observationnelle rétrospective monocentrique. Stroke and Vascular Neurology, 5, 279-284.
[15]
Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q. et al. (2020). Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China. JAMANeurology,77, 683-690. https://doi.org/10.1001/jamaneurol.2020.1127
[16]
Mehra, M. R., Ruschitzka, F., & Patel, A. N. (2020). Retraction—Hydroxychloroquine or Chloroquine with or without a Macrolide for Treatment of COVID-19: A Multinational Registry Analysis. The Lancet, 395, 1820. https://doi.org/10.1016/s0140-6736(20)31324-6
[17]
National Health Commission of the People’s Republic of China (2020). Diagnosticettraitementdelanouvellepneumonieàcoronavirus(versiond’essai 7).
[18]
Oxley, T. J., Mocco, J., Majidi, S., Kellner, C. P., Shoirah, H., Singh, I. P. et al. (2020). Large-vessel Stroke as a Presenting Feature of Covid-19 in the Young. NewEnglandJournalofMedicine,382, e60. https://doi.org/10.1056/nejmc2009787
[19]
Siniscalchi, A., & Gallelli, L. (2020). Could COVID-19 Represent a Negative Prognostic Factor in Patients with Stroke? InfectionControl&HospitalEpidemiology,41, 1115-1116. https://doi.org/10.1017/ice.2020.146
[20]
Siniscalchi, A., Iannacchero, R., Anticoli, S., Romana Pezzella, F., De Sarro, G., & Gallelli, L. (2016). Anti-Inflammatory Strategies in Stroke: A Potential Therapeutic Target. CurrentVascularPharmacology,14, 98-105. https://doi.org/10.2174/1570161113666150923111329
[21]
Smith, M. S., Jordan, B., William, A., Charles, J. P., & Christopher, T. R. (2020). Thérapie endovasculaire pour les patients victimes d’un AVC ischémique aigu pendant la pandémie de COVID-19: Un algorithme proposé. Stroke,51, 1902-1909.
[22]
The RECOVERY Collaborative Group (2021). Dexamethasone in Hospitalized Patients with Covid-19. NewEnglandJournalofMedicine,384, 693-704. https://doi.org/10.1056/nejmoa2021436
[23]
Warren-Gash, C., Blackburn, R., Whitaker, H., McMenamin, J., & Hayward, A. C. (2018). Laboratory-Confirmed Respiratory Infections as Triggers for Acute Myocardial Infarction and Stroke: A Self-Controlled Case Series Analysis of National Linked Datasets from Scotland. EuropeanRespiratoryJournal,51, Article ID: 1701794. https://doi.org/10.1183/13993003.01794-2017
[24]
Wu, Y., Xu, X., Chen, Z., Duan, J., Hashimoto, K., Yang, L. et al. (2020). Nervous System Involvement after Infection with COVID-19 and Other Coronaviruses. Brain,Behavior,andImmunity,87, 18-22. https://doi.org/10.1016/j.bbi.2020.03.031
[25]
Xu, Z., Shi, L., Wang, Y., Zhang, J., Huang, L., Zhang, C. et al. (2020). Pathological Findings of COVID-19 Associated with Acute Respiratory Distress Syndrome. TheLancetRespiratoryMedicine,8, 420-422. https://doi.org/10.1016/s2213-2600(20)30076-x
[26]
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z. et al. (2020). Clinical Course and Risk Factors for Mortality of Adult Inpatients with COVID-19 in Wuhan, China: A Retrospective Cohort Study. TheLancet,395, 1054-1062. https://doi.org/10.1016/s0140-6736(20)30566-3