de Marcellus Charles, Dupic Laurent, Roux Charles-Joris, El Aouane El Ghomari Imane, Parize Perrine, Luscan Romain, Moulin Florence, Kossorotoff Manoelle
Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.
Université de Paris, Paris, France.
Front Neurol. 2021 Apr 8;12:606617. doi: 10.3389/fneur.2021.606617. eCollection 2021.
Neurologic manifestations associated with Covid-19 are increasingly reported, especially stroke and acute cerebrovascular events. Beyond cardiovascular risk factors associated with age, some young adults without medical or cardiovascular history had stroke as a presenting feature of Covid-19. Suggested stroke mechanisms in this setting are inflammatory storm, subsequent hypercoagulability, and vasculitis. To date, a handful of pediatric stroke cases associated with Covid-19 have been reported, either with a cardioembolic mechanism or a focal cerebral arteriopathy. We report the case of an adolescent who presented with febrile meningism and stupor. Clinical, biological, and radiological features favored the diagnosis of Lemierre syndrome (LS), with infection (sphenoid sinusitis and meningitis) and intracranial vasculitis. The patient had concurrent SARS-CoV-2 infection. Despite medical and surgical antimicrobial treatment, stroke prevention, and venous thrombosis prevention, he presented with severe cerebrovascular complications. Venous thrombosis and stroke were observed, with an extension of intracranial vasculitis, and lead to death. As both and SARS-CoV-2 enhance inflammation, coagulation, and activate endothelial cells, we discuss how this coinfection may have potentiated and aggravated the usual course of LS. The potentiation by SARS-CoV-2 of vascular and thrombotic effects of a bacterial infection may represent an underreported cerebrovascular injury mechanism in Covid-19 patients. These findings emphasize the variety of mechanisms underlying stroke in this disease. Moreover, in the setting of SARS-CoV-2 pandemic, we discuss in what extent sanitary measures, namely, lockdown and fear to attend medical facilities, may have delayed diagnosis and influenced outcomes. This case also emphasizes the role of clinical assessment and the limits of telemedicine for acute neurological condition diagnosis.
与新冠病毒病（Covid-19）相关的神经系统表现报告越来越多，尤其是中风和急性脑血管事件。除了与年龄相关的心血管危险因素外，一些没有病史或心血管病史的年轻人也以中风作为Covid-19的首发特征。在这种情况下，推测的中风机制是炎症风暴、随后的高凝状态和血管炎。迄今为止，已经报告了少数与Covid-19相关的儿童中风病例，其机制要么是心源性栓塞，要么是局灶性脑动脉病变。我们报告了一名青少年病例，该患者表现为发热性脑膜刺激征和昏迷。临床、生物学和放射学特征支持勒米尔综合征（LS）的诊断，伴有感染（蝶窦炎和脑膜炎）和颅内血管炎。该患者同时感染了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。尽管进行了药物和手术抗菌治疗、预防中风和预防静脉血栓形成，但他仍出现了严重的脑血管并发症。观察到静脉血栓形成和中风，伴有颅内血管炎扩展，并导致死亡。由于[此处原文缺失相关内容]和SARS-CoV-2都会加重炎症、凝血并激活内皮细胞，我们讨论了这种合并感染可能如何增强和加重了LS的通常病程。SARS-CoV-2对细菌感染的血管和血栓形成作用的增强可能代表了Covid-19患者中一种未被充分报道的脑血管损伤机制。这些发现强调了该疾病中中风的多种潜在机制。此外，在SARS-CoV-2大流行的背景下，我们讨论了卫生措施，即封锁和害怕前往医疗机构，在多大程度上可能延迟了诊断并影响了结果。该病例还强调了临床评估的作用以及远程医疗在急性神经系统疾病诊断方面的局限性。
