Malignant Cerebral Ischemic Stroke Associated with COVID-19 Infection

Abstract

Introduction: Coronavirus Disease 2019 (COVID-19) originating from Wuhan, China, is spreading around the world. Apart from respiratory, cardiac and vascular complications, acute neurological symptoms and acute cerebrovascular disease have also been observed. Methods: A 36 year old female with severe cerebral stroke and COVID pneumonia and its clinical characteristics and evolution are described. Results of two retrospective studies about the incidence of Cerebrovascular Disease (CVD) amongst the positive cases for the new coronavirus are shown. An evaluation of the relationship between CVD and previous infections, their stational distribution, and the possible causes of this damage out of the brain is described. Result: Yanan Li, et al found a 6% of CVD. Ling Mao, et al showed a 5% only amongst the patients defined as severe. Non-severe patients had a 0.8 % incidence. These authors found that in patients with more risk factors that could present more often a severe disease and CVD, some of these factors could in fact be common for a pneumonia or stroke. We could observe that respiratory infections are described risk factors for CVD, especially for cervico-cerebral Artery Dissections (CAD). The seasonal variation also suggests a possible association. It is not well known how the new coronavirus spreads through the human body from the lungs. A possible triggering mechanism might be through the interaction with the Angiotensin-Converting Enzyme-2 (ACE-2) or the cytokine cascade that could create blood coagulation disorders. Conclusion: At this stage of the pandemic, we do not yet know much about the ability of the new coronavirus to produce CVD. This single case report only suggests a possible association between COVID-19 and CVD. More cases with epidemiological data are required to confirm and measure this association, although the role of infections in CVD through a not well-defined mechanism has been described frequently.