COVID-19 with ischemic stroke manifestations

Maria Belladonna Rahmawati; Yovita Andhitara; Rahmi Ardhini; Aditya Kurnianto; Amelia Carissa Pertiwi; Rony Parlindungan Sinaga; Adinda Larastiti

doi:10.15562/bmj.v10i1.2209

COVID-19 with ischemic stroke manifestations

Maria Belladonna Rahmawati ,

Yovita Andhitara ,

Rahmi Ardhini ,

Aditya Kurnianto ,

Amelia Carissa Pertiwi ,

Rony Parlindungan Sinaga ,

Adinda Larastiti ,

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DOI: https://doi.org/10.15562/bmj.v10i1.2209 |
Published: 2021-04-30

Abstract

Background: Continuous pandemic caused by coronavirus disease (COVID-19) have been associated with high morbidity and mortality. COVID-19 has been linked to a hypercoagulable state that causes cerebrovascular complications. The most common cerebrovascular complication is ischemic stroke.

Case Presentations: We report six cases of ischemic stroke with COVID-19, age 51-81 years old, consists of four males and two females. The main risk factors are hypertension and diabetes mellitus. Brain CT scan showed large vessel ischemic stroke in four patients. The patients were treated with Low Molecular Weighted Heparin followed by dual antiplatelet (aspirin and clopidogrel). The outcome was good recovery with minimal sequelae in four patients and death in two patients.

Conclusion: Most of the stroke type in COVID-19 is large vessel disease, with main risk factors of hypertension and diabetes mellitus. Treatment with low molecular weight heparin (LMWH) followed by dual antiplatelet showed promising clinical improvement.

References

World Health Organization (WHO). Novel Coronavirus (2019-nCoV) situation reports [Internet]. Geneve: WHO; (Cited October 29, 2020). Available from: https://www.worldometers.info/coronavirus/
Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, Hou C, Wang H, Liu J, Yang D, Xu Y, Cao Z, Gao Z. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. 2020;24(1):422. doi: 10.1186/s13054-020-03120-0.
Reddy ST, Garg T, Shah C, Nascimento FA, Imran R, Kan P, Bowry R, Gonzales N, Barreto A, Kumar A, Volpi J, Misra V, Chiu D, Gadhia R, Savitz SI. Cerebrovascular Disease in Patients with COVID-19: A Review of the Literature and Case Series. Case Rep Neurol. 2020;12(2):199-209. doi: 10.1159/000508958.
Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. doi: 10.1001/jamaneurol.2020.1127.
Jillella DV, Janocko NJ, Nahab F, Benameur K, Greene JG, Wright WL, Obideen M, Rangaraju S. Ischemic stroke in COVID-19: An urgent need for early identification and management. PLoS One. 2020;15(9):e0239443. doi: 10.1371/journal.pone.0239443.
Ghoreishi A, Arsang-Jang S, Sabaa-Ayoun Z, Yassi N, Sylaja PN, Akbari Y, et al. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results. J Stroke Cerebrovasc Dis. 2020;29(12):105321. doi: 10.1016/j.jstrokecerebrovasdis.2020.105321.
Ntaios G, Michel P, Georgiopoulos G, Guo Y, Li W, Xiong J, et al. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke. 2020;51(9):e254-e258. doi: 10.1161/STROKEAHA.120.031208.
Spence JD, de Freitas GR, Pettigrew LC, Ay H, Liebeskind DS, Kase CS, Del Brutto OH, Hankey GJ, Venketasubramanian N. Mechanisms of Stroke in COVID-19. Cerebrovasc Dis. 2020;49(4):451-458. doi: 10.1159/000509581.
Tan YK, Goh C, Leow AST, Tambyah PA, Ang A, Yap ES, Tu TM, Sharma VK, Yeo LLL, Chan BPL, Tan BYQ. COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis. 2020;50(3):587-595. doi: 10.1007/s11239-020-02228-y.

[1] World Health Organization (WHO). Novel Coronavirus (2019-nCoV) situation reports [Internet]. Geneve: WHO; (Cited October 29, 2020). Available from: https://www.worldometers.info/coronavirus/

[2] Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, Hou C, Wang H, Liu J, Yang D, Xu Y, Cao Z, Gao Z. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. 2020;24(1):422. doi: 10.1186/s13054-020-03120-0.

[3] Reddy ST, Garg T, Shah C, Nascimento FA, Imran R, Kan P, Bowry R, Gonzales N, Barreto A, Kumar A, Volpi J, Misra V, Chiu D, Gadhia R, Savitz SI. Cerebrovascular Disease in Patients with COVID-19: A Review of the Literature and Case Series. Case Rep Neurol. 2020;12(2):199-209. doi: 10.1159/000508958.

[4] Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. doi: 10.1001/jamaneurol.2020.1127.

[5] Jillella DV, Janocko NJ, Nahab F, Benameur K, Greene JG, Wright WL, Obideen M, Rangaraju S. Ischemic stroke in COVID-19: An urgent need for early identification and management. PLoS One. 2020;15(9):e0239443. doi: 10.1371/journal.pone.0239443.

[6] Ghoreishi A, Arsang-Jang S, Sabaa-Ayoun Z, Yassi N, Sylaja PN, Akbari Y, et al. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results. J Stroke Cerebrovasc Dis. 2020;29(12):105321. doi: 10.1016/j.jstrokecerebrovasdis.2020.105321.

[7] Ntaios G, Michel P, Georgiopoulos G, Guo Y, Li W, Xiong J, et al. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke. 2020;51(9):e254-e258. doi: 10.1161/STROKEAHA.120.031208.

[8] Spence JD, de Freitas GR, Pettigrew LC, Ay H, Liebeskind DS, Kase CS, Del Brutto OH, Hankey GJ, Venketasubramanian N. Mechanisms of Stroke in COVID-19. Cerebrovasc Dis. 2020;49(4):451-458. doi: 10.1159/000509581.

[9] Tan YK, Goh C, Leow AST, Tambyah PA, Ang A, Yap ES, Tu TM, Sharma VK, Yeo LLL, Chan BPL, Tan BYQ. COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis. 2020;50(3):587-595. doi: 10.1007/s11239-020-02228-y.

COVID-19 with ischemic stroke manifestations

Abstract

References

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