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(searched for: doi:10.1101/2021.04.30.21256383)
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Qian Zhang, Jian Li,
Frontiers in Public Health, Volume 10; https://doi.org/10.3389/fpubh.2022.937008

Abstract:
Background: The characteristic symptom of coronavirus disease 2019 (COVID-19) is respiratory distress, but neurological symptoms are the most frequent extra-pulmonary symptoms. This study aims to explore the current status and hot topics of neurology-related research on COVID-19 using bibliometric analysis.Methods: Publications regarding neurology and COVID-19 were retrieved from the Web of Science Core Collection (WoSCC) on March 28 2022. The Advanced search was conducted using “TS = (‘COVID 19’ or ‘Novel Coronavirus 2019’ or ‘Coronavirus disease 2019’ or ‘2019-nCOV’ or ‘SARS-CoV-2’ or ‘coronavirus-2’) and TS = (‘neurology’or ‘neurological’ or ‘nervous system’ or ‘neurodegenerative disease’ or ‘brain’ or ‘cerebra’ or ‘nerve’)”. Microsoft Excel 2010 and VOSviewer were used to characterize the largest contributors, including the authors, journals, institutions, and countries. The hot topics and knowledge network were analyzed by CiteSpace and VOSviewer.Results: A total of 5,329 publications between 2020 and 2022 were retrieved. The United States, Italy, and the United Kingdom were three key contributors to this field. Harvard Medical School, the Tehran University of Medical Sciences, and the UCL Queen Square Institute of Neurology were the major institutions with the largest publications. Josef Finsterer from the University of São Paulo (Austria) was the most prolific author. Tom Solomon from the University of Liverpool (UK) was the most cited author. Neurological Sciences and Frontiers in Neurology were the first two most productive journals, while Journal of Neurology held the first in terms of total citations and citations per publication. Cerebrovascular diseases, neurodegenerative diseases, encephalitis and encephalopathy, neuroimmune complications, neurological presentation in children, long COVID and mental health, and telemedicine were the central topics regarding the neurology-related research on COVID-19.Conclusion: Neurology-related research on COVID-19 has attracted considerable attention worldwide. Research topics shifted from “morality, autopsy, and telemedicine” in 2020 to various COVID-19-related neurological symptoms in 2021, such as “stroke,” “Alzheimer's disease,” “Parkinson's disease,” “Guillain–Barre syndrome,” “multiple sclerosis,” “seizures in children,” and “long COVID.” “Applications of telemedicine in neurology during COVID-19 pandemic,” “COVID-19-related neurological complications and mechanism,” and “long COVID” require further study.
A. B. Sugraliyev,
Aterotromboz = Atherothrombosis, Volume 12; https://doi.org/10.21518/2307-1109-2022-12-1-114-126

Abstract:
The coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) stimulated the development of highly effective vaccines that were produced with unprecedented speed with the use of new technologies. All the newly developed vaccines are highly effective with minimal adverse effects. Clinical introduction of the AstraZeneca Covid-19 vaccine has raised public alarm regarding the rare, but serious thrombotic events, known as vaccine-induced immune thrombotic thrombocytopenia (VITT). VITT is characterized clinical and laboratory syndromes like: venous (acute cerebral sinus venous thrombosis and abdominal vein thrombosis) or arterial thrombosis; mild-to-severe thrombocytopenia; positive antiplatelet factor 4 (PF4)-polyanion antibodies or anti-PF4–heparin antibodies detected by ELISA; occurring 5–30 days after ChAdOx1 nCoV-19 (AstraZeneca) or Ad26. COV2.S (Johnson & Johnson/Janssen) vaccination and elevated D-dimer. From a pathophysiological point of view, VITT is an autoimmune disease characterized by the development of antibodies that directly activate platelets, causing thrombosis in the arterial or venous systems of the body. At the same time, the components of the vaccine serve as an antigen for the formation of autoantibodies, which enhance the production of platelet factor PF4, which contributes to the formation of blood clots. It has established that intravenous use of immunoglobulin at a dose of 1 g/kg of the patient’s body weight per day, in addition to neutralizing antibodies, makes it possible to suppress VITT-mediated platelet activation. Fondaparinux, direct oral anticoagulants (DOACs), danaparoid or argatroban are the main anticoagulant drugs effective in the treatment of thrombotic conditions in VITT.
Ghizlane Elaidouni, Zaima Chetouani, Choukri Bahouh Manal Merbouh, Houssam Bkiyar, Brahim Housni
Published: 1 June 2022
Radiology Case Reports, Volume 17, pp 1942-1945; https://doi.org/10.1016/j.radcr.2022.02.082

Majid Mohammed Mahmood
Journal of Cardiology and Cardiovascular Research; https://doi.org/10.37191/mapsci-jccr-3(2)-055

Abstract:
COVID-19 is a viral disease that infected most of the people on the planet as a pandemic. The disease is attributed to the SARS-CoV-2 virus, which causes respiratory symptoms, vascular disorders and can infect more body systems. This article aims to expand the list of causes of blood clotting as well as to focus the light on the links between blood clots and the virus which was always blamed to cause thrombosis. From the literature, reasons of blood coagulation consist of 3 main categories: non-infectious, infectious, and medications. Some medications used in the international therapeutic protocol for COVID-19 might cause blood coagulation such as zinc, glucocorticoids, and favipiravir which are not well studied. Finally, new causes of thrombosis are recently added to the list which are SARS-CoV-2, some therapeutics used for COVID-19 treatment strategy, and COVID-19 vaccines. In conclusion, SARS-CoV-2 may cause blood clots, but it is not the only reason. COVID-19, some medicines used to treat patients, and COVID-19 vaccines are added to the list of causes of blood clots despite the rare incidence of blood clots recorded in vaccinated people.
Jeongsu Hwang, Jong-Hee Sohn, Sang-Hwa Lee, Eungue Lee, Wonseok Jeon, Yerim Kim
Journal of the Korean Neurological Association, Volume 40, pp 160-163; https://doi.org/10.17340/jkna.2022.2.10

Abstract:
Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular attack and its predisposing factors commonly co-exist. In the coronavirus disease 2019 (COVID-19) era, various side effects of COVID-19 vaccine have been reported, and CVT is one of the well-known types. It is usually explained as prothrombotic immune thrombocytopenia by an antibody binding to platelet factor 4 receptor. However, some cases are irrelevant to thrombocytopenia and calls for a new explanation. Here we report a case of CVT without thrombocytopenia after COVID-19 vaccination.
Laleh Eslamian, Seyedeh Noushin Ghalandarpoor-Attar, Azadeh Shabani, Seyedeh Mojgan Ghalandarpoor-Attar
Journal of Medical Case Reports, Volume 16, pp 1-5; https://doi.org/10.1186/s13256-022-03377-9

Abstract:
Background: Although coronavirus disease 2019 affects mainly the respiratory system, as time passes and our understanding of the disease improves, many nonrespiratory clinical manifestations such as thromboembolic events have been shown to occur with or without respiratory tract involvement. Case presentation: We present the case of a 21-year-old gravid 3, live 1, abortion 1 Iranian woman pregnant with twins in her early first trimester. Her initial chief complaint was headache that gradually increased in intensity. Eventually, cerebral vein thrombosis was confirmed. Although the patient first manifested with neurological involvement, she developed upper respiratory symptoms soon after, and then nasopharyngeal polymerase chain reaction test returned positive. Conclusion: Any neurological complaints in pregnant women during the current coronavirus disease 2019 pandemic should raise suspicion for the presence of significant cerebral thrombotic or ischemic events, even if the patient has no complaint of respiratory tract involvement and/or when an initial nasopharyngeal polymerase chain reaction test is negative.
Published: 17 March 2022
Abstract:
Infection with SARS-CoV-2 is causing coronavirus disease in 2019 (COVID-19). Besides respiratory symptoms due to an attack on the broncho-alveolar system, COVID-19, among others, can be accompanied by neurological symptoms because of the affection of the nervous system. These can be caused by intrusion by SARS-CoV-2 of the central nervous system (CNS) and peripheral nervous system (PNS) and direct infection of local cells. In addition, neurological deterioration mediated by molecular mimicry to virus antigens or bystander activation in the context of immunological anti-virus defense can lead to tissue damage in the CNS and PNS. In addition, cytokine storm caused by SARS-CoV-2 infection in COVID-19 can lead to nervous system related symptoms. Endotheliitis of CNS vessels can lead to vessel occlusion and stroke. COVID-19 can also result in cerebral hemorrhage and sinus thrombosis possibly related to changes in clotting behavior. Vaccination is most important to prevent COVID-19 in the nervous system. There are symptomatic or/and curative therapeutic approaches to combat COVID-19 related nervous system damage that are partly still under study.
Hans-Christoph Diener, Peter Berlit, Christian Gerloff, Dagny Holle-Lee, Tobias Kurth, Jörg B. Schulz
Published: 19 January 2022
InFo Neurologie & Psychiatrie, Volume 24, pp 32-43; https://doi.org/10.1007/s15005-021-2149-4

, Abdallah Elshafeey, Malik Mushannen, Hussam Kawas, Ameena Shafiq, Narjis Mhaimeed, Omar Mhaimeed, Nada Mhaimeed, Rached Zeghlache, Mohammad Salameh, et al.
Journal of Cellular and Molecular Medicine, Volume 26, pp 636-653; https://doi.org/10.1111/jcmm.17137

The publisher has not yet granted permission to display this abstract.
Paul M. McKeigue, Raj Burgul, Jen Bishop, Chris Robertson, Jim McMenamin, Maureen O’Leary, David A. McAllister,
Published: 20 December 2021
BMC Infectious Diseases, Volume 21, pp 1-9; https://doi.org/10.1186/s12879-021-06960-5

Abstract:
Background: To investigate the association of primary acute cerebral venous thrombosis (CVT) with COVID-19 vaccination through complete ascertainment of all diagnosed CVT in the population of Scotland. Methods: Case-crossover study comparing cases of CVT recently exposed to vaccination (1–14 days after vaccination) with cases less recently exposed. Cases in Scotland from 1 December 2020 were ascertained through neuroimaging studies up to 17 May 2021 and diagnostic coding of hospital discharges up to 28 April 2021, linked to national vaccination records. The main outcome measure was primary acute CVT. Results: Of 50 primary acute CVT cases, 29 were ascertained only from neuroimaging studies, 2 were ascertained only from hospital discharges, and 19 were ascertained from both sources. Of these 50 cases, 14 had received the Astra-Zeneca ChAdOx1 vaccine and 3 the Pfizer BNT162b2 vaccine. The incidence of CVT per million doses in the first 14 days after vaccination was 2.2 (95% credible interval 0.9 to 4.1) for ChAdOx1 and 1 (95% credible interval 0.1 to 2.9) for BNT162b2. The rate ratio for CVT associated with exposure to ChAdOx1 in the first 14 days compared with exposure 15-84 days after vaccination was 3.2 (95% credible interval 1.1 to 9.5). Conclusions: These findings support a causal association between CVT and the AstraZeneca vaccine. The absolute risk of post-vaccination CVT in this population-wide study in Scotland was lower than has been reported for populations in Scandinavia and Germany; the explanation for this is not clear.
Tobias Braun, Maxime Viard, Martin Juenemann, Tobias Struffert, Frank Schwarm, Hagen B. Huttner,
Published: 22 November 2021
Frontiers in Neurology, Volume 12; https://doi.org/10.3389/fneur.2021.763049

Abstract:
We present two cases of ChAdOx1 nCov-19 (AstraZeneca)-associated thrombotic thrombocytopenia syndrome (TTS) and cerebral venous sinus thrombosis (CVST). At the time of emergency room presentation due to persistent headache, blood serum levels revealed reduced platelet counts. Yet, 1 or 4 days after the onset of the symptom, the first MR-angiography provided no evidence of CVST. Follow-up imaging, performed upon headache refractory to nonsteroidal pain medication verified CVST 2–10 days after initial negative MRI. Both the patients received combined treatment with intravenous immunoglobulins and parenteral anticoagulation leading to an increase of platelet concentration in both the individuals and resolution of the occluded cerebral sinus in one patient.
Anil Mane, Rohan Ainchwar, Harshawardhan Dhanraj Ramteke
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH pp 48-51; https://doi.org/10.36106/ijsr/2407282

Abstract:
In the recent studies, COVID-19 vaccines, especially Covishield has been associated with the reports of Vaccine-Induced pulmonary thromboembolism. pulmonary thromboembolism is a complication that can occur after the rst dose of the vaccine causing the thrombosis in veins at specic sites like lungs, Brain and Deep Veins and Arteries. It presents commonly as the Pulmonary Embolism (PE), within 7-10 days of vaccination. Patients taking vaccinations under the age of 45 presents at the high risk. Mortality rate in such post vaccination thrombosis is considered to be 50% in some cases. Thus, it is far more important to understand and identify the early signs and symptoms for early diagnosis, proper treatment and interventions. In the following case presented. A 29-year-old male patient was presented with the complaints of High Fever, Cough and Extreme Breathlessness after receiving the rst dose of ChADOx1 nCoV-19 Vaccination against the Corona Virus Disease 2019 (COVID-19). He had history of Exertional Dyspnoea for 2-3 weeks. He was diagnosed to have Pulmonary Embolism with severe PAH. 2D ECHO was done which showed Severe Pulmonary Hypertension Likely Pulmonary Thromboembolism, Good biventricular systolic function, Mild TR. CT Chest with Pulmonary Angiography was done which showed Eccentric lling defect seen in bilateral arteries at hila with extension in lower lobe segment branches- likely thrombus. CT Scan of Thorax (Plain & Contrast) was also done which showed bilateral small patchy ground glass haze with superimposed Reticular thickening mainly in Subpleural region. He was immediately thrombolysed with Intrapulmonary TNK after doing Check angiography. He was then managed with Oxygen support, NIV support, Inj. Fondaparinux, Anti biotics, Anti-coagulant, diuretics, Pulmonary vasodilators, Anti-hypertensive, and other supportive drugs. He responded well to the given treatment and was gradually weaned off NIV and oxygen support. Serial D-dimer, CBC, Chest X ray monitoring was done. Repeat CT chest was done in view of fresh lesions on Chest X ray which showed cavitatory lesion in Right mid zone with moderate Pleural effusion. Chest Physician consultation was taken and advice followed accordingly. He was discharged after 19 days, later he was then taken up for follow up every 2 weeks
Po-Hsu Su, Yi-Ching Yu, Wen-Hsin Chen, Hsuan-Ching Lin, Yih-Ting Chen, Ming-Huei Cheng, Yen-Min Huang
Published: 1 November 2021
Frontiers in Medicine, Volume 8; https://doi.org/10.3389/fmed.2021.772424

Abstract:
Vaccination plays an important role during the COVID-19 pandemic. Vaccine-induced thrombotic thrombocytopenia (VITT) is a major adverse effect that could be lethal. For cancer patients, cancer-related thromboembolism is another lethal complication. When cancer patients receive their COVID-19 vaccines, the following thromboembolic events will be more complicated. We presented a case recently diagnosed with pancreatic cancer, who had received the mRNA-1273 (Moderna) vaccination 12 days prior. Ischemic stroke and VITT were also diagnosed. We aggressively treated the patient with steroids, immunoglobulin, and plasma exchange. The titer of anti-platelet factor four and d-dimer level decreased, but the patient ultimately died. The complicated condition of VITT superimposed cancer-related thromboembolism was considered. To our knowledge, only one case of mRNA-1273 related VITT was reported, and this case study was the first to report a cancer patient who was diagnosed with VITT after mRNA-1273 vaccination. Therefore, when the need for vaccination among cancer patients increased under the current COVID-19 pandemic, the possible risk of VITT for cancer patients should be carefully managed. Further studies of the risk evaluation of the COVID-19 vaccine in cancer patients might be required in the future.
, Bernhard O. Boehm
Published: 27 August 2021
Thrombosis Research, Volume 206, pp 137-138; https://doi.org/10.1016/j.thromres.2021.08.018

The publisher has not yet granted permission to display this abstract.
, Raj Burgul, Jen Bishop, , Jim McMenamin, Maureen O’Leary, ,
Published: 24 August 2021
Abstract:
Objectives To investigate the association of primary acute cerebral venous thrombosis (CVT) with COVID-19 vaccination through complete ascertainment of all diagnosed CVT in the population of Scotland. Design Case-crossover study comparing recent (1-14 days after vaccination) with less recent exposure to vaccination among cases of CVT. Setting National data for Scotland from 1 December 2020, with diagnosed CVT case ascertainment through neuroimaging studies up to 17 May 2021 and diagnostic coding of hospital discharges up to 28 April 2021 and with linkage to vaccination records. Main outcome measure Primary acute cerebral venous thrombosis Results Of 50 primary acute CVT cases, 29 were ascertained only from neuroimaging studies, 2 were ascertained only from hospital discharges, and 19 were ascertained from both sources. Of these 50 cases, 14 had received the Astra-Zeneca ChAdOx1 vaccine and 3 the Pfizer BNT162b2 vaccine. The incidence of CVT per million doses in the first 14 days after vaccination was 2.2 (95% credible interval 0.9 to 4.1) for ChAdOx1 and 1 (95% credible interval 0.1 to 2.9) for BNT162b2. The rate ratio for CVT associated with exposure to ChAdOx1 in the first 14 days compared with exposure 15-84 days after vaccination was 3.2 (95% credible interval 1.1 to 9.5). The 95% credible interval for the rate ratio associated with recent versus less recent exposure to BNT162b2 (0.6 to 95.8) was too wide for useful inference. Conclusions These findings support a causal association between CVT and the AstraZeneca vaccine. The absolute risk of post-vaccination CVT in this population-wide study in Scotland was lower than has been reported for populations in Scandinavia and Germany; the explanation for this is not clear. What is already known on this topic The risk of cerebral venous thrombosis (CVT) within 28 days of receiving the AstraZeneca ChAdOx1 vaccine has been estimated as 18 to 25 per million doses in Germany and Scandinavia, but only 5 per million doses in the UK based on the Yellow Card reporting scheme. Risk estimates based on adverse event reporting systems are subject to under-ascertainment and other biases. What this study adds All diagnosed cases of CVT in Scotland were ascertained by searching neuroimaging studies from December 2020 to May 2021 and linked to national vaccination records. The risk of CVT within 28 days of vaccination with ChAdOx1 was estimated as 3.5 per million doses with an upper bound of 6 per million doses, against a background incidence of about 12 per million adults per year. This indicates that the Yellow Card system has not seriously underestimated the risk in the UK; the explanation for higher risk in other European countries is not clear.
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