Northwestern University, Feinberg School of Medicine, Ken and Ruth Davee Department of Neurology.
Northwestern University, Feinberg School of Medicine, Department of Internal Medicine.
J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105542. doi: 10.1016/j.jstrokecerebrovasdis.2020.105542. Epub 2020 Dec 9.
OBJECTIVE: To report six consecutive patients with confirmed coronavirus disease-2019 (COVID-19) who underwent Transcranial Doppler (TCD) ultrasonography evaluation for cerebral microemboli in the setting of suspected or confirmed acute ischemic stroke. METHODS: Patient data were obtained from medical records from Northwestern Memorial Hospital, Chicago, IL between May and June 2020. All patients with confirmed COVID-19 who underwent clinical TCD ultrasonography for microemboli detection were included. RESULTS: A total of eight TCD studies were performed in six patients with COVID-19 (4 men and 2 women, median age 65±5), four with confirmed ischemic stroke and two with refractory encephalopathy. Microemboli were detected in three male patients, two patients had suffered a confirmed ischemic stroke and one who developed prolonged encephalopathy. Microemboli of varying intensity were identified in multiple vascular territories in two patients, and microemboli persisted despite therapeutic anticoagulation in a third patient. Of the three patients without evidence of microemboli on TCD ultrasonography, two patients had suffered a confirmed ischemic stroke, while one remained with refractory encephalopathy. CONCLUSIONS: TCD ultrasonography for microemboli detection identified three patients with confirmed COVID-19 with evidence of cerebral arterial microemboli, including one who was therapeutically anticoagulated. TCD ultrasonography provides a non-invasive method for evaluating cerebral microemboli in patients with COVID-19 and may be useful in assessing response to treatment in cases with suspected or confirmed disorders of hypercoagulability. Further studies investigating the prevalence of cerebral microemboli and associated risk factors are needed to characterize their pathogenic mechanism and guide therapeutic interventions in hospitalized COVID-19 patients.
目的:报告 6 例连续确诊的 2019 年冠状病毒病(COVID-19)患者,这些患者在疑似或确诊急性缺血性卒中的情况下接受经颅多普勒(TCD)超声检查评估脑微栓子。
方法:从 2020 年 5 月至 6 月期间,芝加哥西北纪念医院的病历中获取患者数据。所有接受过 TCD 超声检查以检测微栓子的 COVID-19 确诊患者均被纳入研究。
结果:6 例 COVID-19 患者(4 名男性和 2 名女性,中位年龄 65±5)共进行了 8 次 TCD 研究,其中 4 例确诊为缺血性卒中,2 例为难治性脑病。3 例男性患者检测到微栓子,其中 2 例患者确诊为缺血性卒中,1 例患者发生了持续性脑病。2 例患者多个血管区域存在不同程度的微栓子,1 例患者尽管进行了抗凝治疗,微栓子仍持续存在。在 TCD 超声检查未发现微栓子的 3 例患者中,2 例患者确诊为缺血性卒中,1 例患者仍存在难治性脑病。
结论:TCD 超声检测微栓子的方法在 3 例确诊 COVID-19 患者中发现了脑动脉微栓子的证据,其中 1 例患者接受了抗凝治疗。TCD 超声检查为评估 COVID-19 患者的脑微栓子提供了一种非侵入性方法,在疑似或确诊高凝状态障碍的患者中,可能有助于评估治疗反应。进一步研究需要确定脑微栓子的患病率及其相关危险因素,以阐明其发病机制,并指导住院 COVID-19 患者的治疗干预。
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