Department of Emergency Neurology and Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy.
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Eur J Neurol. 2022 Feb;29(2):615-619. doi: 10.1111/ene.15128. Epub 2021 Oct 6.
Acute ischemic stroke (AIS) is a common complication of coronavirus disease 2019 (COVID-19), but the underlying biological mechanisms remain unclear. We aimed to describe the prevalence of vessel wall alterations in patients with cryptogenic stroke through vessel wall magnetic resonance imaging (vwMRI).
All consecutive patients admitted for AIS and COVID-19 to a single neuro-COVID unit from 10 November to 31 December 2020 were prospectively evaluated and underwent a complete etiologic workup for AIS. In patients with cryptogenic stroke, the diagnostic workup was completed with vwMRI study.
After the exclusion of four patients ineligible for MRI, a total of 10 patients were included (median age = 78 years, 50% males), of whom four (40%) had a cryptogenic stroke. vwMRI showed vascular changes consistent with inflammation of intracranial artery walls in three subjects (75%). Two patients had focal and one multifocal involvement.
vwMRI detected signs of vascular inflammation in the majority of patients with cryptogenic AIS, leading to an etiologic definition with potential therapeutical implications. Our findings are best interpreted as hypothesis-generating, suggesting the possibility of expanding the diagnostic workup of cryptogenic stroke with vessel wall imaging.
急性缺血性脑卒中（AIS）是 2019 年冠状病毒病（COVID-19）的常见并发症，但潜在的生物学机制尚不清楚。我们旨在通过血管壁磁共振成像（vwMRI）描述隐源性脑卒中患者血管壁改变的患病率。
2020 年 11 月 10 日至 12 月 31 日，我们连续前瞻性评估了因 AIS 且 COVID-19 入住单一神经 COVID-19 病房的所有患者，并对其进行了 AIS 的全面病因学检查。对于隐源性脑卒中患者，采用 vwMRI 研究完成诊断性检查。
排除了 4 名不符合 MRI 条件的患者后，共纳入 10 名患者（中位年龄为 78 岁，50%为男性），其中 4 名（40%）患有隐源性脑卒中。vwMRI 显示 3 名患者（75%）的颅内动脉壁存在炎症性血管变化。2 名患者存在局灶性病变，1 名患者存在多灶性病变。
vwMRI 在大多数隐源性 AIS 患者中检测到血管炎症的迹象，从而确定了具有潜在治疗意义的病因学定义。我们的发现最好被解释为产生假说，提示有可能通过血管壁成像扩大隐源性脑卒中的诊断性检查。
