Osada Takahiro, Aoki Rie, Hanano Hideyuki, Yasuda Takashi, Imai Masaaki, Sakakibara Yumetaro, Kurokawa Sachiko, Chin Yuka, Tokuoka Kentaro, Sakamaki Fumio, Oda Shinri, Shimoda Masami, Nogawa Shigeru
Department of Neurosurgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
J Neuroendovasc Ther. 2021;15(4):246-253. doi: 10.5797/jnet.cr.2020-0134. Epub 2020 Nov 18.
Coronavirus disease 2019 (COVID-19) is characterized by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and presents with respiratory symptoms. Overall, 5.7% of COVID-19 patients with severe respiratory status have been reported to develop acute cerebrovascular diseases (CVDs), and 41.3% of COVID-19 cases were considered nosocomial infections. Therefore, Protected Code Stroke, which is a guideline for acute stroke management that takes into account the safety of healthcare workers, has been developed. We created an operational manual for COVID-19 in the endovascular treatment center of our hospital and report our experience treating acute stroke in a COVID-19 patient.
A 67-year-old man presented with a 5-day history of fever. Chest CT showed ground glass opacity (GGO) on admission, and the polymerase chain reaction (PCR) test for COVID-19 was positive. Dysarthria, right-sided hemiparesis, and aphasia were discovered on the morning of the third day after hospitalization. MRI showed an acute ischemic stroke at the left corona radiata and occlusion of the left middle cerebral artery (MCA). Progression of right-sided hemiparesis and exacerbation of respiratory status developed after the MRI. Tracheal intubation was performed, and the patient was treated with intravenous alteplase and mechanical thrombectomy (MT). Recanalization of blood flow was not obtained, and the neurological deficits remained.
MT was performed for large-vessel occlusion (LVO) in a COVID-19 patient during the COVID-19 pandemic. Safety for healthcare workers and appropriate rapid treatment for acute stroke patients are both vital in the current environment.
2019冠状病毒病（COVID-19）以严重急性呼吸综合征冠状病毒2（SARS-CoV-2）为特征，表现为呼吸道症状。总体而言，据报道，5.7%的重症COVID-19患者会发生急性脑血管疾病（CVD），41.3%的COVID-19病例被认为是医院感染。因此，制定了《保护代码卒中》，这是一项考虑到医护人员安全的急性卒中管理指南。我们为我院血管内治疗中心编写了COVID-19操作手册，并报告我们治疗COVID-19患者急性卒中的经验。
一名67岁男性，有5天发热病史。入院时胸部CT显示磨玻璃影（GGO），COVID-19聚合酶链反应（PCR）检测呈阳性。住院第三天早晨发现构音障碍、右侧偏瘫和失语。MRI显示左侧放射冠急性缺血性卒中，左侧大脑中动脉（MCA）闭塞。MRI检查后右侧偏瘫进展，呼吸状况恶化。进行了气管插管，患者接受了静脉注射阿替普酶和机械取栓术（MT）。血流未再通，神经功能缺损仍然存在。
在COVID-19大流行期间，对一名COVID-19患者进行了大血管闭塞（LVO）的MT治疗。在当前环境下，医护人员的安全和对急性卒中患者的适当快速治疗都至关重要。
