Departments of Neurology.
Neuroradiology.
Neurologist. 2022 May 1;27(3):143-146. doi: 10.1097/NRL.0000000000000403.
Thrombotic events are potentially devastating complications of coronavirus disease 2019 (COVID-19) infection. Although less common than venous thromboembolism, arterial thrombosis has been reported in COVID-19 cohorts in almost 3% of patients. We describe a patient with COVID-19 infection and concurrent cerebral and noncerebral infarction.
A 53-year-old man with history of COVID-19 pneumonia was admitted to a primary stroke center for speech disturbances and left hemiplegia. Urgent laboratory tests showed a great increase of inflammatory and coagulation parameters as D-dimer, ferritin, interleukin-6 and C-reactive protein. Neuroimaging found occlusion of the M1 segment of the right middle cerebral artery with early signs of ischemic stroke. He received intravenous thrombolysis and mechanical thrombectomy. Abdominal computed tomography discovered a splenic infarction with hemorrhagic transformation and bilateral renal infarction. Urgent angiography showed an associated splenic pseudoaneurysm, which was embolized without complications. He was treated with intermediate-dose anticoagulation (1 mg subcutaneous enoxaparin/kg/24 h), acetylsalicylic acid 100 mg and 5 days of intravenous corticosteroids. In the following days, inflammatory markers decreased so anticoagulant treatment was stopped and acetylsalicylic acid 300 mg was prescribed. His condition improved and he was discharged to a rehabilitation facility on hospital day 30.
In this case, a patient with multiple thrombotic events in the acute phase of COVID-19 infection, the delimitation of the inflammatory state through analytical markers as D-dimer helped to individualize the antithrombotic treatment (full anticoagulation or anticoagulation at intermediate doses plus antiplatelet treatment as used in our patient) and its duration. However, more data are needed to better understand the mechanisms and treatment of stroke in patients with COVID-19 infection.
血栓事件是 2019 年冠状病毒病（COVID-19）感染的潜在破坏性并发症。尽管比静脉血栓栓塞症少见，但在 COVID-19 患者中，已有近 3%的患者报告发生动脉血栓形成。我们描述了一例 COVID-19 感染合并脑内和非脑梗死的患者。
一名 53 岁男性，有 COVID-19 肺炎病史，因言语障碍和左侧偏瘫入住一级卒中中心。紧急实验室检查显示炎症和凝血参数明显增加，如 D-二聚体、铁蛋白、白细胞介素-6 和 C-反应蛋白。神经影像学发现右侧大脑中动脉 M1 段闭塞，有早期缺血性卒中迹象。他接受了静脉溶栓和机械取栓治疗。腹部计算机断层扫描发现脾梗死伴出血性转化和双侧肾梗死。紧急血管造影显示脾假性动脉瘤伴发，无并发症栓塞。他接受了中等剂量抗凝治疗（1mg 皮下依诺肝素/kg/24h）、100mg 乙酰水杨酸和 5 天静脉皮质类固醇治疗。在接下来的几天里，炎症标志物下降，因此停止抗凝治疗并开了 300mg 乙酰水杨酸。他的病情改善，在入院第 30 天出院到康复机构。
在本例中，一名 COVID-19 感染急性期发生多处血栓形成的患者，通过 D-二聚体等分析标志物来界定炎症状态，有助于个体化抗血栓治疗（如本例患者使用的全剂量抗凝或中剂量抗凝联合抗血小板治疗）及其持续时间。然而，需要更多的数据来更好地了解 COVID-19 感染患者卒中的发病机制和治疗方法。
