Pablo J de la Fuente
Volume1-Issue1
Dates: Received: 2020-05-06 | Accepted: 2020-05-26 | Published: 2020-05-27
Pages: 003-007
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.
FullText HTML
FullText PDF
DOI: 10.37871/jels1112
Certificate of Publication

Copyright
© 2020 de la Fuente PJ, et al. Distributed under Creative Commons CC-BY 4.0
How to cite this article
de la Fuente PJ, Pomposo IC, Zabalo G, Altamirano JE, Paternain C, Sistiaga I, Iglesias JM, Bilbao G, Carrasco A, Carbayo G, Catalan G, de Gopegui ER, Galbarriatu L, Bermudez G, Guio L. Malignant Cerebral Ischemic Stroke Associated with COVID-19 Infection. J Biomed Res Environ Sci. 2020 May 27; 1(1): 003-007. doi: 10.37871/jels1112
Subject area(s)
University/Institute
References
- Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, et al. Clinical Characteristics of Coronavirus Disease 2019. N Engl J Med. 2020; 382: 1708-1720.
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 Novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323: 1061-1069. PubMed: https://pubmed.ncbi.nlm.nih.gov/32031570/
- Li Y, Wang M, Zhou Y, Chang J, Xian Y et al. Acute cerebrovascular disease following COVID-19: A single center. Retrospective, Observational Study. LANCET. 2020.
- Ling Mao, Huijuan Jin, Mengdie Wang, Yu Hu, Shengcai Chen, Quanwei He, et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series. JAMA Neurol. 2020; 201127: PubMed: https://pubmed.ncbi.nlm.nih.gov/32275288/
- A J Grau, F Buggle, S Heindl, C Steichen Wiehn, T Banerjee, M Maiwald, et al. Recent bacterial and viral infection is a risk factor for cerebrovascular ischemia. Clinical and biochemical studies. Neurology. 1998; 50: 196-203. PubMed: https://pubmed.ncbi.nlm.nih.gov/7886709/
- A J Grau, T Brandt, F Buggle, E Orberk, J Mytilineos, E Werle, et al. Association of cervical artery dissection with recent infection. Arch Neurol. 1999; 56: 851-856. PubMed: https://pubmed.ncbi.nlm.nih.gov/10404987/
- Benoit Guillon, Karine Berthet, Lamia Benslamia, Marion Bertrand, Marie Germaine Bousser, Christophe Tzourio. Infection and the risk of spontaneous cervical artery dissection: a case-control study. Stroke. 2003; 34: 79-81. PubMed: https://pubmed.ncbi.nlm.nih.gov/12805497/
- Lucy C Thomas, Lesley Ann Hall, John R Attia, Elizabeth G Holliday, Hugh S Markus, Christopher R Levi. Seasonal variation in spontaneous cervical artery dissection: Comparing between UK and Australian Sites. J Stroke Cerebrovasc Dis. 2017; 26: 177-185. PubMed: https://pubmed.ncbi.nlm.nih.gov/27745777/
- Baumgartner RW. Handbook on cerebral artery dissection. Frontiers of Neurology and Neuroscience. Karge. 2005; 20: 12-15.
- Schievink WI, Mokri B, O'Fallon WM. Recurrent spontaneous cervical-artery dissection. N Engl J Med. 1994; 330: 393-397. PubMed: https://pubmed.ncbi.nlm.nih.gov/8284004/
- Bogousslavsky J, Pierre P. Ischemic stroke in patients under age 45. Neurol Clin. 1992; 10: 113-124. PubMed: https://pubmed.ncbi.nlm.nih.gov/1556998/
- Arboix A, Jimenez C, Massons J, Parra O, Besses C. Hematological disordes: A commonly unrecognized cause of acute stroke. Expert review of hematology. 2016; 9: 891-901. PubMed: https://pubmed.ncbi.nlm.nih.gov/27367035/
- Schievink WI, Wijdicks EFM, Michels VV, Vockley J, Godfrey M. Heritable connective tissue disorders in cervical artery dissections: A prospective study. Neurology. 1998; 50: 1166-1169. PubMed: https://pubmed.ncbi.nlm.nih.gov/9566419/
- Sofia Morfopoulou, Julianne R Brown, E Graham Davies, Glenn Anderson, Alex Virasami, Waseem Qasim, et al. Human Coronavirus OC43 Associated with Fatal Encephalitis. N Engl J Med. 2016; 375: 497-498.
- Hussein Algahtani, Ahmad Subahi, Bader Shirah. Neurological complications of middle east respiratory syndrome coronavirus: A report of two cases and review of the Literature. Case Rep Neurol Med. 2016; 3502683; PubMed: https://pubmed.ncbi.nlm.nih.gov/27239356/
- Carod Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol. 2020; 70: 311‐322. PubMed: https://pubmed.ncbi.nlm.nih.gov/32329044/
- Wenhui Li, Chengsheng Zhang, Jianhua Sui, Jens H Kuhn, Michael J Moore, Shiwen Luo, et al. Receptor and viral determinants of SARS-coronavirus adaptation to human ACE2. EMBO J. 2005; 24: 1634-1643. PubMed: https://pubmed.ncbi.nlm.nih.gov/15791205/
- Sajjad Muhammad, Emanuel Haasbach, Maria Kotchourko, Anne Strigli, Antje Krenz, Dirk A Ridder, et al. Influenza virus infection aggravates stroke outcome. Stroke. 2011; 42: 783-791. PubMed: https://pubmed.ncbi.nlm.nih.gov/21293018/
- Zhe Xu, Lei Shi, Yijin Wang, Jiyuan Zhang, Lei Huang, Chao Zhang, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8: 420-422. PubMed: https://pubmed.ncbi.nlm.nih.gov/32085846/
- Arboix A, Garcia Eroles L, Oliveres M, Comes E, Sanchez MJ, Massons J. Malignant middle cerebral artery infarction: A clinical study of 32 patients. Rev Invest Clin. 2015; 67: 64-70. PubMed: https://pubmed.ncbi.nlm.nih.gov/25857586/
- Arboix A, Alio J. Acute cardioembolic stroke: an update. Expert Rev Cardiovasc Ther. 2011; 9: 367-379. PubMed: https://pubmed.ncbi.nlm.nih.gov/21438816/