Reader response: Neurologic complications of coronavirus infections
Lucrecia N.Bandeo, Neurologist, Hospital Británico de Buenos Aires
PabloBonardo, Neurologist, Hospital Británico de Buenos Aires
Manuel M.Fernandez Pardal, Neurologist, Hospital Británico de Buenos Aires
Ricardo C.Reisin, Neurologist, Hospital Británico de Buenos Aires
Submitted June 09, 2020
We read with interest the editorial by Avindra Nath.1 Stroke is briefly mentioned and it is not included in the table that summarizes the clinical syndromes associated with SARS-CoV-2 infection.
Ischemic and hemorrhagic strokes have been reported in up to 22% of patients with COVID-19 infection and were associated with a ~2.5 fold increased disease severity.2 Moreover, stroke may be the first clinical manifestation of COVID-19 infection even in young patients lacking cardiovascular risk factors.3,4 It is likely that the frequency of stroke might be even higher considering that acute cerebrovascular disease in critically ill patients may not be diagnosed due to impaired consciousness or confounding systemic illness.3
Several different pathophysiology mechanisms may explain stroke in COVID-19 patients, including renin angiotensin aldosterone dysbalance, vasculopathy, thromboinflammation, and cardiac damage.5
Neurologists should have high awareness of COVID-19 infection among patients presenting with stroke. Strategies like early imaging of the lungs as well as prompt screening for SARS-CoV-2 infection and adequate protection of the exposed neurologists attending patients with stroke should be implemented.6
Disclosure
The authors report no relevant disclosures. Contact [email protected] for full disclosures.
References
Nath A. Neurologic complications of coronavirus infections. Neurology 2020;94:809–810. doi:10.1212/WNL.0000000000009455.
Aggarwal G, Lippi G, Henry BM. Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): A pooled analysis of published literature. Int J Stroke 2020;15:385–389.
Yaghi S, Ishida K, Torres J, et al. SARS2-CoV-2 and stroke in a New York healthcare system. Stroke. 2020 Epub May 20.
Henry BM, Vikse J, Benoit S, Favaloro EJ, Lippi G Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: A novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis. Clin Chim Acta 2020;507:167–173.
Leira EC, Russman AN, Biller J, et al. Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions. Neurology 2020 Epub May 8.
We read with interest the editorial by Avindra Nath.1 Stroke is briefly mentioned and it is not included in the table that summarizes the clinical syndromes associated with SARS-CoV-2 infection.
Ischemic and hemorrhagic strokes have been reported in up to 22% of patients with COVID-19 infection and were associated with a ~2.5 fold increased disease severity.2 Moreover, stroke may be the first clinical manifestation of COVID-19 infection even in young patients lacking cardiovascular risk factors.3,4 It is likely that the frequency of stroke might be even higher considering that acute cerebrovascular disease in critically ill patients may not be diagnosed due to impaired consciousness or confounding systemic illness.3
Several different pathophysiology mechanisms may explain stroke in COVID-19 patients, including renin angiotensin aldosterone dysbalance, vasculopathy, thromboinflammation, and cardiac damage.5
Neurologists should have high awareness of COVID-19 infection among patients presenting with stroke. Strategies like early imaging of the lungs as well as prompt screening for SARS-CoV-2 infection and adequate protection of the exposed neurologists attending patients with stroke should be implemented.6
Disclosure
The authors report no relevant disclosures. Contact [email protected] for full disclosures.
References