tetano
Editor, Senior Moderator
Neurosurg Open
. 2020 Sep;1(3)
kaa008.
doi: 10.1093/neuopn/okaa008. Epub 2020 Jul 17.
Outcomes and Spectrum of Major Neurovascular Events Among COVID-19 Patients: A 3-Center Experience
Blake E S Taylor[SUP] 1 [/SUP], Priyank Khandelwal[SUP] 1 [/SUP], Michael S Rallo[SUP] 2 [/SUP], Purvee Patel[SUP] 1 [/SUP], Lindsey Smith[SUP] 3 [/SUP], Hai Sun[SUP] 4 [/SUP], Anil Nanda[SUP] 1 [/SUP], Amit Singla[SUP] 1 [/SUP], Sudipta Roychowdhury[SUP] 4 [/SUP], Roger C Cheng[SUP] 5 [/SUP], Kiwon Lee[SUP] 5 [/SUP], Gaurav Gupta[SUP] 1 [/SUP], Stephen A Johnson[SUP] 4 [/SUP]
Affiliations
Abstract
Background: Preliminary data suggest that Coronavirus Disease-2019 (COVID-19) is associated with hypercoagulability and neurovascular events, but data on outcomes is limited.
Objective: To report the clinical course and outcomes of a case series of COVID-19 patients with a variety of cerebrovascular events.
Methods: We performed a multicentric, retrospective chart review at our three academic tertiary care hospitals, and identified all COVID-19 patients with cerebrovascular events requiring neuro-intensive care and/or neurosurgical consultation.
Results: We identified 26 patients between March 1 and May 24, 2020, of whom 12 (46%) died. The most common event was a large-vessel occlusion (LVO) in 15 patients (58%), among whom 8 died (8/15, 53%). A total of 9 LVO patients underwent mechanical thrombectomy, of whom 5 died (5/9, 56%). A total of 7 patients (27%) presented with intracranial hemorrhage. Of the remaining patients, 2 had small-vessel occlusions, 1 had cerebral venous sinus thrombosis, and another had a vertebral artery dissection. Acute Respiratory Distress Syndrome occurred in 8 patients, of whom 7 died. Mortalities had a higher D-dimer on admission (mean 20 963 ng/mL) than survivors (mean 3172 ng/mL). Admission Glasgow Coma Scale (GCS) score was poor among mortalities (median 7), whereas survivors had a favorable GCS at presentation (median 14) and at discharge (median 14).
Conclusion: COVID-19 may be associated with hemorrhage as well as ischemia, and prognosis appears poorer than expected-particularly among LVO cases, where outcome remained poor despite mechanical thrombectomy. However, a favorable neurological condition on admission and lower D-dimer may indicate a better outcome.
Keywords: COVID-19; Cerebral venous sinus thrombosis; Intracranial hemorrhage; Large-vessel occlusion (LVO).
. 2020 Sep;1(3)
kaa008.doi: 10.1093/neuopn/okaa008. Epub 2020 Jul 17.
Outcomes and Spectrum of Major Neurovascular Events Among COVID-19 Patients: A 3-Center Experience
Blake E S Taylor[SUP] 1 [/SUP], Priyank Khandelwal[SUP] 1 [/SUP], Michael S Rallo[SUP] 2 [/SUP], Purvee Patel[SUP] 1 [/SUP], Lindsey Smith[SUP] 3 [/SUP], Hai Sun[SUP] 4 [/SUP], Anil Nanda[SUP] 1 [/SUP], Amit Singla[SUP] 1 [/SUP], Sudipta Roychowdhury[SUP] 4 [/SUP], Roger C Cheng[SUP] 5 [/SUP], Kiwon Lee[SUP] 5 [/SUP], Gaurav Gupta[SUP] 1 [/SUP], Stephen A Johnson[SUP] 4 [/SUP]
Affiliations
- PMID: 34632389
- PMCID: PMC7454798
- DOI: 10.1093/neuopn/okaa008
Abstract
Background: Preliminary data suggest that Coronavirus Disease-2019 (COVID-19) is associated with hypercoagulability and neurovascular events, but data on outcomes is limited.
Objective: To report the clinical course and outcomes of a case series of COVID-19 patients with a variety of cerebrovascular events.
Methods: We performed a multicentric, retrospective chart review at our three academic tertiary care hospitals, and identified all COVID-19 patients with cerebrovascular events requiring neuro-intensive care and/or neurosurgical consultation.
Results: We identified 26 patients between March 1 and May 24, 2020, of whom 12 (46%) died. The most common event was a large-vessel occlusion (LVO) in 15 patients (58%), among whom 8 died (8/15, 53%). A total of 9 LVO patients underwent mechanical thrombectomy, of whom 5 died (5/9, 56%). A total of 7 patients (27%) presented with intracranial hemorrhage. Of the remaining patients, 2 had small-vessel occlusions, 1 had cerebral venous sinus thrombosis, and another had a vertebral artery dissection. Acute Respiratory Distress Syndrome occurred in 8 patients, of whom 7 died. Mortalities had a higher D-dimer on admission (mean 20 963 ng/mL) than survivors (mean 3172 ng/mL). Admission Glasgow Coma Scale (GCS) score was poor among mortalities (median 7), whereas survivors had a favorable GCS at presentation (median 14) and at discharge (median 14).
Conclusion: COVID-19 may be associated with hemorrhage as well as ischemia, and prognosis appears poorer than expected-particularly among LVO cases, where outcome remained poor despite mechanical thrombectomy. However, a favorable neurological condition on admission and lower D-dimer may indicate a better outcome.
Keywords: COVID-19; Cerebral venous sinus thrombosis; Intracranial hemorrhage; Large-vessel occlusion (LVO).