[Source: Neurosurgery Open, full page: (LINK). Abstract, edited.]
Outcomes and Spectrum of Major Neurovascular Events Among COVID-19 Patients: A 3-Center Experience
Blake E S Taylor, MD, Priyank Khandelwal, MD, Michael S Rallo, BS, Purvee Patel, MD, Lindsey Smith, BSN, RN, SCRN, Hai Sun, MD, PhD, Anil Nanda, MD, MPH, Amit Singla, MD, Sudipta Roychowdhury, MD, Roger C Cheng, MD, Kiwon Lee, MD, Gaurav Gupta, MD, Stephen A Johnson, MD
Neurosurgery Open, Volume 1, Issue 3, September 2020, okaa008, https://doi.org/10.1093/neuopn/okaa008
Published: 17 July 2020
Preliminary data suggest that Coronavirus Disease-2019 (COVID-19) is associated with hypercoagulability and neurovascular events, but data on outcomes is limited.
To report the clinical course and outcomes of a case series of COVID-19 patients with a variety of cerebrovascular events.
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.
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).
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.
COVID-19, Large-vessel occlusion (LVO), Intracranial hemorrhage, Cerebral venous sinus thrombosis
Issue Section: Case Series
Keywords: SARS-CoV-2; COVID-19; Neurosurgery; Neurology; Stroke.