Department of Neurology.
Research Laboratory LR12SP01, Charles Nicolle Hospital.
Neurologist. 2021 Nov 4;26(6):276-280. doi: 10.1097/NRL.0000000000000367.
Protein S deficiency and coronavirus disease 2019 (COVID-19) are rare etiologies of ischemic stroke. We describe a case of an ischemic stroke revealing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a patient with a history of protein S deficiency and cerebral imaging suggestive of vasculitis.
A 52-year-old woman, with history of protein S deficiency, was admitted for right hemiparesis and aphasia that happened 6 hours before her consultation. Her National Institutes of Health Stroke Scale (NIHSS) was 11. She had hypoxia (SpO2 93%). COVID-19 polymerase chain reaction was positive. Cerebral computed tomography scan showed an ischemic stroke in the territory of the superficial left middle cerebral artery. The recommended time period for thrombolysis was exceeded and we did not dispose of sufficient resources to deliver thrombectomy. She was treated with aspirin, statins, antibiotic therapy, and oxygen. Considering the high risk of thromboembolic complications and the history of protein S deficiency, anticoagulation treatment with heparin followed by acenocoumarol was started. Evolution was marked by the appearance of 24 hours regressive, acute symptoms of confusion. Brain magnetic resonance imaging showed new ischemic strokes in both anterior cerebral arteries and on magnetic resonance angiography narrowing of the left internal carotid artery and both anterior cerebral arteries suggestive of vasculitis was seen. We maintained anticoagulation and prescribed methylprednisolone 500 mg daily for 3 days. Evolution was marked by improvement of clinical deficit and respiratory status.
SARS-CoV-2 infection potentializes the prothrombotic effect and vascular inflammation by accentuating protein S deficit. The place of steroids seems justifiable in the presence of symptoms of vasculitis in brain imaging.
蛋白 S 缺乏症和 2019 年冠状病毒病（COVID-19）是缺血性卒中的罕见病因。我们描述了一例蛋白 S 缺乏症患者发生缺血性卒中，该患者合并严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染，且脑部影像学提示血管炎。
一名 52 岁女性，有蛋白 S 缺乏症病史，因右侧偏瘫和失语症就诊，症状发生在就诊前 6 小时。她的国立卫生研究院卒中量表（NIHSS）评分为 11 分。她有缺氧（SpO2 93%）。COVID-19 聚合酶链反应阳性。脑计算机断层扫描显示左侧大脑中动脉浅支区域的缺血性卒中。超过了溶栓的推荐时间窗，且我们没有足够的资源进行取栓。她接受了阿司匹林、他汀类药物、抗生素治疗和吸氧治疗。考虑到血栓栓塞并发症的高风险和蛋白 S 缺乏症的病史，开始给予肝素抗凝治疗，随后给予华法林。演变过程中出现了 24 小时的急性意识混乱症状消退。脑磁共振成像显示两侧大脑前动脉和磁共振血管造影显示左侧颈内动脉和两侧大脑前动脉狭窄有新的缺血性卒中，提示血管炎。我们维持抗凝治疗，并开了 3 天每天 500mg 甲泼尼龙。临床症状和呼吸状况都有所改善。
SARS-CoV-2 感染通过加重蛋白 S 缺乏症，增强了促血栓形成作用和血管炎症。在脑影像学存在血管炎症状的情况下，类固醇的应用似乎是合理的。
