Coronavirus disease 2019 (COVID-19) related stroke incidence: a case series

https://doi.org/10.19106/JMedSci005503202307

Hanindia Riani Prabaningtyas(1*), Maria Yosita Ayu Hapsari(2), Stefanus Erdana Putra(3), Muhammad Hafizhan(4), Diah Kurnia Mirawati(5), Pepi Budianto(6), Subandi Subandi(7), Rivan Danuaji(8)

(1) Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta,
(2) Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta,
(3) Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta,
(4) Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta,
(5) Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta,
(6) Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta,
(7) Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta,
(8) Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta,
(*) Corresponding Author

Abstract


Coronavirus disease 2019 (COVID-19) can cause systemic and respiratory symptoms. Acute respiratory distress syndrome (ARDS), anemia, acute heart injury, secondary infection, and stroke are the complications of COVID-19. Age, oxidative stress, endothelial dysfunction, inflammatory status, vascular risk factors, and hypoxemia are risk factors for stroke associated with COVID-19. In this case report, two cases of COVID-19 complicated by stroke and other thromboembolic diseases were discussed. Case 1: a 46-year-old man presented with right extremities weakness, dysarthria, cough, colds, chest pain radiating to left upper extremity. He was diagnosed with moderate COVID-19, with complication of embolic stroke and myocardial infarction. After administration of IV furosemid and recombinant tissue plasminogen activator (rTPA), his condition improved, and he was discharged from our facility. Case 2: a 54-year-old woman presented with a decreased level of consciousness, skin discoloration, tenderness on her left calf, cough, fever, and shortness of breath. She was diagnosed with moderate COVID-19 with a complication of thrombotic stoke and deep vein thrombosis (DVT). She was treated with rTPA, IV citicoline, and fondaparinux for 5 days. In conclusion, COVID-19 carries a risk of thromboembolic complication. COVID-19 patients have a higher risk of bleeding, therefore, medications, particularly anticoagulant, should be administered with more caution.


Keywords


COVID-19; stroke; SARS-CoV-2; risk factors; thromboembolic

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References

Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun 2020; 87:18-22.
https://doi.org/10.1016/j.bbi.2020.03.031
2. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135(23):2033-40.
https://doi.org/10.1182/blood.2020006000
3. Zhai P, Ding Y, Li Y. The impact of COVID-19 on ischemic stroke: a case report. Diagn Pathol 2020; 15(1):78.
https://doi.org/10.1186/s13000-020-00994-0
4. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18(5):1094-9.
https://doi.org/10.1111/jth.14817
5. Morassi M, Bagatto D, Cobelli M, D’Agostini S, Gigli GL, Bnà C, et al. Stroke in patients with SARS-CoV-2 infection: Case series. J Neurol 2020; 267(8):2185-2192.
https://doi.org/10.1007/s00415-020-09885-2
6. Ortega-Paz L, Capodanno D, Montalescot G, Angiolillo DJ. Coronavirus disease 2019–associated thrombosis and coagulopathy: Review of the pathophysiological characteristics and implications for antithrombotic management. J Am Heart Assoc 2021; 10(3):e019650.
https://doi.org/10.1161/JAHA.120.019650
7. Needham EJ, Chou SHY, Coles AJ, Menon DK. Neurological implications of COVID-19 infections. Neurocrit Care 2020; 32(3):667-71.
https://doi.org/10.1007/s12028-020-00978-4
8. Rahman A, Tabassum T, Araf Y, Al Nahid A, Ullah MA, Hosen MJ. Silent hypoxia in COVID-19: pathomechanism and possible management strategy. Mol Biol Rep 2021; 48(4):3863-9.
https://doi.org/10.1007/s11033-021-06358-1
9. McGonagle D, Sharif K, O’Regan A, Bridgewood C. The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmun Rev 2020; 19(6):102537.
https://doi.org/10.1016/j.autrev.2020.102537
10. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395(10229):1054-62.
https://doi.org/10.1016/S0140-6736(20)30566-3
11. Beyrouti R, Adams ME, Benjamin L, Cohen H, Farmer SF, Goh YY, et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2019; 92(7):889-91.
https://doi.org/10.1136/jnnp-2020-323586
12. Salahuddin H, Castonguay AC, Zaidi SF, Burgess R, Jadhav AP, Jumaa MA. Interventional stroke care in the era of COVID-19. Front Neurol 2020; 11:468.
https://doi.org/10.3389/fneur.2020.00468
13. Brüggemann R, Gietema H, Jallah B, Cate H ten, Stehouwer C, Spaetgens B. Arterial and venous thromboembolic disease in a patient with COVID-19: a case report. Thromb Res 2020; 191:153-5.
https://doi.org/10.1016/j.thromres.2020.04.046
14. Nagele PM, Haubner B, Tanner FC, Ruschitzka F, Flammer AJ. Endothelial dysfunction in COVID-19: current findings and therapeutic implications. Atherosclerosis 2020; 314:58-62.
https://doi.org/10.1016/j.atherosclerosis.2020.10.014
15. Al Saiegh F, Ghosh R, Leibold A, Avery MB, Schmidt RF, Theofanis T, et al. Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke. J Neurol Neurosurg Psychiatry 2020; 91(8):846-8.
https://doi.org/10.1136/jnnp-2020-323522
16. Khosravani H, Rajendram P, Notario L, Chapman MG, Menon BK. Protected code stroke: hyperacute stroke management during the coronavirus disease 2019 (COVID-19) pandemic. Stroke 2020; 51(6):1891-5.
https://doi.org/10.1161/STROKEAHA.120.029838
17. Hughes C, Nichols T, Pike M, Subbe C, Elghenzai S. Cerebral venous sinus thrombosis as a presentation of COVID-19. Eur J Case Reports Intern Med 2020; 7(5):001691.
https://doi.org/10.12890/2020_001691
18. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 2020; 382(20):e60.
https://doi.org/10.1056/NEJMc2100787
19. Burhan E, Susanto AD, Nasution SA, Eka G, Pitoyo ceva W, Susilo A, et al. Pedoman tatalaksana COVID-19 edisi 4. Jakarta: PDPI, PERKI, PAPDI, PERDATIN, IDAI, 2022.
20. Jin H, Hong C, Chen S, Zhou Y, Wang Y, Mao L, et al. Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Stroke Vasc Neurol 2020; 5(2):146-51.
https://doi.org/10.1136/svn-2020-000382



DOI: https://doi.org/10.19106/JMedSci005503202307

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Copyright (c) 2023 Hanindia Riani Prabaningtyas, Maria Yosita Ayu Hapsari, Stefanus Erdana Putra, Muhammad Hafizhan, Diah Kurnia Mirawati, Pepi Budianto, Subandi Subandi, Rivan Danuaji

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