Taylor Blake E S, Khandelwal Priyank, Rallo Michael S, Patel Purvee, Smith Lindsey, Sun Hai, Nanda Anil, Singla Amit, Roychowdhury Sudipta, Cheng Roger C, Lee Kiwon, Gupta Gaurav, Johnson Stephen A
Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Neurosurg Open. 2020 Sep;1(3):okaa008. doi: 10.1093/neuopn/okaa008. Epub 2020 Jul 17.
Preliminary data suggest that Coronavirus Disease-2019 (COVID-19) is associated with hypercoagulability and neurovascular events, but data on outcomes is limited.
To report the clinical course and outcomes of a case series of COVID-19 patients with a variety of cerebrovascular events.
We performed a multicentric, retrospective chart review at our three academic tertiary care hospitals, and identified all COVID-19 patients with cerebrovascular events requiring neuro-intensive care and/or neurosurgical consultation.
We identified 26 patients between March 1 and May 24, 2020, of whom 12 (46%) died. The most common event was a large-vessel occlusion (LVO) in 15 patients (58%), among whom 8 died (8/15, 53%). A total of 9 LVO patients underwent mechanical thrombectomy, of whom 5 died (5/9, 56%). A total of 7 patients (27%) presented with intracranial hemorrhage. Of the remaining patients, 2 had small-vessel occlusions, 1 had cerebral venous sinus thrombosis, and another had a vertebral artery dissection. Acute Respiratory Distress Syndrome occurred in 8 patients, of whom 7 died. Mortalities had a higher D-dimer on admission (mean 20 963 ng/mL) than survivors (mean 3172 ng/mL). Admission Glasgow Coma Scale (GCS) score was poor among mortalities (median 7), whereas survivors had a favorable GCS at presentation (median 14) and at discharge (median 14).
COVID-19 may be associated with hemorrhage as well as ischemia, and prognosis appears poorer than expected-particularly among LVO cases, where outcome remained poor despite mechanical thrombectomy. However, a favorable neurological condition on admission and lower D-dimer may indicate a better outcome.
初步数据表明，2019冠状病毒病（COVID-19）与高凝状态和神经血管事件相关，但关于结局的数据有限。
报告一系列发生各种脑血管事件的COVID-19患者的临床病程和结局。
我们在三家学术性三级医疗中心进行了一项多中心回顾性病历审查，确定了所有因脑血管事件需要神经重症监护和/或神经外科会诊的COVID-19患者。
我们在2020年3月1日至5月24日期间确定了26例患者，其中12例（46%）死亡。最常见的事件是15例（58%）发生大血管闭塞（LVO），其中8例死亡（8/15，53%）。共有9例LVO患者接受了机械取栓术，其中5例死亡（5/9，56%）。共有7例患者（27%）出现颅内出血。其余患者中，2例发生小血管闭塞，1例发生脑静脉窦血栓形成，另1例发生椎动脉夹层。8例患者发生急性呼吸窘迫综合征，其中7例死亡。死亡患者入院时D-二聚体水平（平均20963 ng/mL）高于存活患者（平均3172 ng/mL）。死亡患者入院时格拉斯哥昏迷量表（GCS）评分较差（中位数7分），而存活患者入院时（中位数14分）和出院时（中位数14分）GCS评分良好。
COVID-19可能与出血和缺血均有关，预后似乎比预期的更差，尤其是在LVO病例中，尽管进行了机械取栓术，结局仍然不佳。然而，入院时神经功能良好和D-二聚体水平较低可能表明结局较好。
