Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
Department of Pediatric Endocrinology, Children Hospital of Philadelphia, Philadelphia, USA.
Int J Stroke. 2020 Oct;15(7):733-742. doi: 10.1177/1747493020937189. Epub 2020 Jun 26.
The coronavirus disease 2019 is associated with neurological manifestations including stroke.
We present a case series of coronavirus disease 2019 patients from two institutions with acute cerebrovascular pathologies. In addition, we present a pooled analysis of published data on large vessel occlusion in the setting of coronavirus disease 2019 and a concise summary of the pathophysiology of acute cerebrovascular disease in the setting of coronavirus disease 2019.
A retrospective study across two institutions was conducted between 20 March 2020 and 20 May 2020, for patients developing acute cerebrovascular disease and diagnosed with coronavirus disease 2019. We performed a literature review using the PubMed search engine.
The total sample size was 22 patients. The mean age was 59.5 years, and 12 patients were female. The cerebrovascular pathologies were 17 cases of acute ischemic stroke, 3 cases of aneurysm rupture, and 2 cases of sinus thrombosis. Of the stroke and sinus thrombosis patients, the mean National Institute of Health Stroke Scale was 13.8 ± 8.0, and 16 (84.2%) patients underwent a mechanical thrombectomy procedure. A favorable thrombolysis in cerebral infarction score was achieved in all patients. Of the 16 patients that underwent a mechanical thrombectomy, the mortality incidence was five (31.3%). Of all patients (22), three (13.6%) patients developed hemorrhagic conversion requiring decompressive surgery. Eleven (50%) patients had a poor functional status (modified Rankin Score 3-6) at discharge, and the total mortality incidence was eight (36.4%).
Despite timely intervention and favorable reperfusion, the mortality rate in coronavirus disease 2019 patients with large vessel occlusion was high in our series and in the pooled analysis. Notable features were younger age group, involvement of both the arterial and venous vasculature, multivessel involvement, and complicated procedures due to the clot consistency and burden.
2019 年冠状病毒病与包括中风在内的神经系统表现有关。
我们介绍了来自两家机构的伴有急性脑血管病病理的 2019 年冠状病毒病患者的病例系列。此外，我们还对 2019 年冠状病毒病大血管闭塞的已发表数据进行了汇总分析，并简要总结了 2019 年冠状病毒病时急性脑血管病的病理生理学。
对 2020 年 3 月 20 日至 5 月 20 日期间在两家机构发生急性脑血管病并诊断为 2019 年冠状病毒病的患者进行回顾性研究。我们使用 PubMed 搜索引擎进行文献回顾。
总样本量为 22 例。平均年龄为 59.5 岁，12 例为女性。脑血管病包括 17 例急性缺血性中风、3 例动脉瘤破裂和 2 例窦血栓形成。中风和窦血栓形成患者的国立卫生研究院卒中量表平均值分别为 13.8±8.0，16 例（84.2%）患者接受了机械取栓术。所有患者均达到了良好的溶栓后梗死评分。在接受机械取栓的 16 例患者中，死亡率为 5 例（31.3%）。在所有患者（22 例）中，有 3 例（13.6%）发生需要减压手术的出血性转化。11 例（50%）患者出院时功能状态较差（改良 Rankin 评分 3-6），总死亡率为 8 例（36.4%）。
尽管及时干预和再灌注良好，但在我们的系列研究和汇总分析中，2019 年冠状病毒病大血管闭塞患者的死亡率较高。显著特点是年龄较轻、动脉和静脉血管均受累、多血管受累以及由于血栓负荷和一致性导致的复杂操作。
