Clinical and pathogenetic features of cerebral stroke in patients with new corоnavirus infection (COVID-19)
V. V. Andreev,
A. Y. Podunov,
D. S. Lapin,
Z. L. Gilyaeva,
E. N. Nikiforova,
K. V. Golikov,
D. I. Rudenko https://doi.org/10.24884/1682-6655-2020-19-3-46-56
Abstract
We studied the patients had the acute cerebrovascular events after the community acquired pneumonia evoked by new COVID-19 infection. The aim of our paper is improving the diagnosis and treatment of that condition. Materials and methods. We analyzed the stroke clinical features of 121 patient suffering from community acquired pneumonia induced by COVID-19 for the first time. Two groups were formed depending on the proved pulmonary damage. The main group included 69.4 % of patients (n=84) with diagnosis of new coronavirus disease plus stroke. Patients with ischemic and hemorrhage stroke in absence of SARS-CoV-2 signs were formed control group (30.6 %; n=37). We compared severity of the diseases and explored the biochemical characteristics in the both groups. Outcomes of severe cerebral and pulmonary injury were analyzed statistically. Results. Post-stroke patients with coronavirus disease showed predominantly the ischemic stroke (86.4 %) for unspecified (41.4 %) and cardioembolic (35.7%) pathogenetic subtypes (according to TOAST) with localization in the carotid basin (89.7 %). The hemorrhagic stroke more often was accompanied by parenchymal hemorrhage (54.5 %). The severity of the developed stroke according to the NIHSS scale is up to 13.16 (8.80) points with less severe brain damage Glasgow coma scale (14.0 (12.0 15.0). In the group of patients, widespread lung tissue damage was diagnosed in 82,2% of cases. The reliable increase of clinically relevant hypercoagulation signs was absent. Conclusions. Post-stroke patients with COVID-19 mainly have ischemic signs with unspecified and cardioembolic subtypes in absence of any sex and age features. The differences in disease severity are absent. The outcomes of diseases are mainly favorable. The high activity of inflammatory changes is clinically revealed.
About the Authors
V. V. Andreev
City multi-specialty hospital №2; Pavlov University; N. N. Petrov Institute of Oncology
Russian Federation
Russian Federation
Andreev Vladislav V. – Cand. Sci. (Med.), Associate Professor of Department of Neurology and Manual Medicine, Faculty of Postgraduate Education, Pavlov University; neurologist of the Department of Neurology №1 (for patients with cerebrovascular accident), City multi-specialty hospital №2; Neurologist, N. N. Petrov Institute of Oncology. eLibrary SPIN: 6277-8960
5, Uchebniy per., Saint Petersburg, 194354
6-8, L’va Tolstogo street, Saint Petersburg, 197022
68, Leningradskaya str., Pesichniy, Saint Petersburg, 197758
A. Y. Podunov
City multi-specialty hospital №2
Russian Federation
Russian Federation
Podunov Alexander Y. – neurologist of the Department of Neurology №1 (for patients with cerebrovascular accidents)
5, Uchebniy per., Saint Petersburg, 194354
D. S. Lapin
City multi-specialty hospital №2
Russian Federation
Russian Federation
Lapin Daniil S. - neurologist of the Department of Neurology No. 1 (for patients with cerebrovascular accidents)
5, Uchebniy per., Saint Petersburg, 194354
Z. L. Gilyaeva
City multi-specialty hospital №2
Russian Federation
Russian Federation
Gilyaeva Zarema L. – neurologist of the Department of Neurology №1 (for patients with cerebrovascular accidents)
5, Uchebniy per., Saint Petersburg, 194354
E. N. Nikiforova
City multi-specialty hospital №2
Russian Federation
Russian Federation
Nikiforova Ekaterina N. – neurologist of the Department of Neurology №1 (for patients with cerebrovascular accidents)
5, Uchebniy per., Saint Petersburg, 194354
K. V. Golikov
City multi-specialty hospital №2
Russian Federation
Russian Federation
Golikov Konstantin V. – neurologist, head of the department of neurology №1 (for patients with cerebrovascular accidents)
5, Uchebniy per., Saint Petersburg, 194354
D. I. Rudenko
City multi-specialty hospital №2; Pavlov University
Russian Federation
Russian Federation
Rudenko Dmitry I. – PhD, Professor of the Department of Neurology, Pavlov University; deputy. chapters. Doctor, City multi-specialty hospital №2
5, Uchebniy per., Saint Petersburg, 194354
6-8, L’va Tolstogo street, Saint Petersburg, 197022
References
1. Gusev YeI, Skvortsova VI. Ishemiya golovnogo mozga. Moscow, 2001:328. (In Russ.).
2. Damulin IV, Parfenov VA, Skoromets AA et al. Narusheniya krovoobrashcheniya v golovnom i spinnom mozge. In: Bolezni nervnoy sistemy. Rukovodstvo dlya vrachey. Pod red. N. N. Yakhno. Moscow, Meditsina, 2005;1:232–303. (In Russ.).
3. Insul’t: diagnostika, lecheniye i profilaktika. Pod red. Suslinoy ZA, Piradova MA. Moscow, MEDpress-inform, 2008:288. (In Russ.).
4. Feygin V, Vibers D, Braun R. Insul’t: Klinicheskoye rukovodstvo. Moscow, Binom; SPb., Dialekt, 2005:608. (In Russ.).
5. Shevchenko OP, Praskurnichiy YeA, Yakhno NN et al. Arterial’naya gipertoniya i tserebral’nyy insul’t. Moscow, 2001:192. (In Russ.).
6. Adams HP, del Zoppo G, Alberts MJ. Guidelines for the Early Management of Adults With Ischemic Stroke. Stroke. 2007;38:1655–1711.
7. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis. 2008;25:457–507.
8. Insul’t: Rukovodstvo dlya vrachey. Pod red. L. V. Stakhovskoy. Moscow, Meditsinskoye informatsionnoye agentstvo, 2013:400. (In Russ.).
9. Trofimova TN. Neyroradiologiya. SPb., Izdatel’skiy dom SPbMAPO, 2005:172. (In Russ.).
10. Westendorp WF, Vermeij JD, Zock E, Hooijenga IJ, Kruyt ND, Bosboom HJ et al.; PASS investigators. The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomised open-label masked endpoint clinical trial. Lancet. 2015;385(9977):1519–1526. Doi: 10.1016/S0140-6736(14)62456-9.
11. Bustamante A, García-Berrocoso T, Rodriguez N, Llombart V, Ribó M, Molina C et al. Ischemic stroke outcome: A review of the influence of post-stroke complications within the different scenarios of stroke care. Eur. J. Intern. Med. 2016;29:9–21. Doi: 10.1016/j.ejim.2015.11.030.
12. Yan-Chao Li, Wan-Zhu Bai, Tsutomu Hashikawa. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020 Jun;92(6):552–555.
13. Varga Z. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395:1417–1418.
14. Yang X et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir. Med. 2020;8(5):475–481. Doi: 10.1016/S2213-2600(20)30079-5.
Review
For citations:
Andreev V.V., Podunov A.Y., Lapin D.S., Gilyaeva Z.L., Nikiforova E.N., Golikov K.V., Rudenko D.I. Clinical and pathogenetic features of cerebral stroke in patients with new corоnavirus infection (COVID-19). Regional blood circulation and microcirculation. 2020;19(3):46-56. (In Russ.) https://doi.org/10.24884/1682-6655-2020-19-3-46-56
Views:
2610
Email this article 
