Background and purpose Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection predisposes patients to arterial and venous thrombosis. This study aimed to systematically review the available evidence in the literature for cerebral venous thrombosis (CVT) in association with coronavirus disease-2019 (COVID-19). Methods We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases to identify cases of COVID-19-associated CVT. The search period spanned 1 January 2020 to 1 December 2020, and the review protocol (PROSPERO-CRD42020214327) followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Identified studies were evaluated for bias using the Newcastle-Ottawa scale. A proportion meta-analysis was performed to estimate the frequency of CVT among hospitalized COVID-19 patients. Results We identified 57 cases from 28 reports. Study quality was mostly classified as low. CVT symptoms developed after respiratory disease in 90%, and the mean interval was 13 days. CVT involved multiple sites in 67% of individuals, the deep venous system was affected in 37%, and parenchymal hemorrhage was found in 42%. Predisposing factors for CVT beyond SARS-CoV-2 infection were present in 31%. In-hospital mortality was 40%. Using data from 34,331 patients, the estimated frequency of CVT among patients hospitalized for SARS-CoV-2 infection was 0.08% (95% confidence interval [CI]: 0.01-0.5). In an inpatient setting, CVT accounted for 4.2% of cerebrovascular disorders in individuals with COVID-19 (cohort of 406 patients, 95% CI: 1.47-11.39). Conclusions Cerebral venous thrombosis in the context of SARS-CoV-2 infection is a rare, although there seems to be an increased relative risk. High suspicion is necessary, because the diagnosis of this potentially life-threatening condition in COVID-19 patients can be challenging. Evidence is still scarce on the pathophysiology and potential prevention of COVID-19-associated CVT.

Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis.

OBJECTIVE: Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and highlights the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke We conducteda systematic review and meta-analysis to evaluate the aforementioned considerations METHODS: We performed a meta-analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARS-CoV-2 infection status We used a random-effects model Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (95%CI) RESULTS: We identified 18 cohort studies including 67,845 patients Among patients with SARS-CoV-2, 1 3% (95%CI:0 9-1 6%;I(2) =87%) were hospitalized for cerebrovascular events, 1 1% (95%CI:0 8-1 3%;I(2) =85%) for ischemic stroke, and 0 2% (95%CI:0 1-0 3%;I(2) =64%) for hemorrhagic stroke Compared to non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds of ischemic stroke (OR=3 58,95%CI:1 43-8 92;I(2) =43%) and cryptogenic stroke (OR=3 98,95%CI:1 62-9 77;I(2) =0%) Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical controls (OR=1 39, 95%CI:1 04-1 86;I(2) =0%) SARS-CoV-2 infection status was not associated with the likelihood of receiving intravenous thrombolysis (OR=1 42,95%CI:0 65-3 10;I(2) =0%) or endovascular thrombectomy (OR=0 78,95%CI:0 35-1 74;I(2) =0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic Odds for in-hospital mortality were higher among SARS-CoV-2stroke patients compared to non-infected contemporary or historical stroke patients (OR=5 60,95%CI:3 19-9 80;I(2) =45%) INTERPRETATION: SARS-CoV-2 appears to be associated with an increased risk of ischemic stroke, and potentially cryptogenic stroke in particular It may also be related to an increased mortality risk This article is protected by copyright All rights reserved

The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-analysis

OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

https://n.neurology.org/content/neurology/96/23/e2824.full.pdf

Global Impact of COVID-19 on Stroke Care and IV Thrombolysis.

Stroke in patients with COVID-19: Clinical and neuroimaging characteristics.

Coronavirus disease 2019 (COVID-19) results from infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first reported in Wuhan, China in patients suffering from severe pneumonia and acute respiratory distress syndrome and has now grown into the first pandemic in over 100 years. Patients infected with SARS-CoV-2 develop arterial thrombosis including stroke, myocardial infarction and peripheral arterial thrombosis, all of which result in poor outcomes despite maximal medical, endovascular, and microsurgical treatment compared with non-COVID-19-infected patients. In this review we provide a brief overview of SARS-CoV-2, the infectious agent responsible for the COVID-19 pandemic, and describe the mechanisms responsible for COVID-19-associated coagulopathy. Finally, we discuss the impact of COVID-19 on ischemic stroke, focusing on large vessel occlusion.

https://jnis.bmj.com/content/neurintsurg/13/3/202.full.pdf

Ischemic stroke in COVID-19-positive patients: an overview of SARS-CoV-2 and thrombotic mechanisms for the neurointerventionalist.

BackgroundSevere acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients.AimTo summarize the findings of a ...

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Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry.

Chronic Traumatic Encephalopathy in a 25-Year-Old Athlete—Distribution of Lesions To the Editor In the article byMez et al,1 half (5 of 10) of the lesions in the thin section specimen (panel B in the article’s Figure) stained forAT8,are in thesulcaldepthsofgyri. Is this characteristic of chronic traumatic encephalopathy? If these lesions result froman impact-inducedwave in the cerebrospinal fluid of the subarachnoid space, theywould be found at the blind end of a subarachnoid space in the sulcus. Apressurewavewould stretch and tear the cortexwhere it hit the endof the sulcus. This fitswith theknownphysics of pressure transfer across a curvedmembrane, in this case, the fold at the depth of the sulcus. Thepressure difference, ΔP, across a curvedmembrane is inversely proportional to the radius of the curve, ie, ΔP=kP(1/ R), where R is the radius of curvature, P is the pressure being considered, and k is a constant. (The full formula for 3 dimensions is the reciprocal of the sumof the 2 principal radii of the curve. Because the other curve along the fold of the gyrus is very flat, its radius is very large and its reciprocal is very small, thus it can be neglected.) This explains why a pressure pulse wave in the cerebrospinal fluid inflicts its lesions at the blind endof the sac. Similarly, aneurysms blowwhere the curve is greatest, the radius of curvature is smallest, and its reciprocal is largest. What of the other 5 lesions on the flat top of a gyrus? It is suggested that pressure pulse waves in the subarachnoid are reflectedfromotherstructures, suchas theskull.When2waves coincideandcompletely reinforceeachother, they formanode of exceptionally high pressure. Damage to the cortex happens randomly, where these high-pressure nodes form a distributionpredictedmathematically,2 foundradiologically,3 and confirmed pathologically.4,5 Is this distribution characteristic of chronic traumatic encephalopathy and that alone?

Chronic Traumatic Encephalopathy in a 25-Year-Old Athlete—Distribution of Lesions

After Stroke Are Associated With Worse Outcome'' Letter by Urra et al Regarding Article, ''Autoimmune Responses to the Brain

Poster: "ECR 2010 / C-2595 / Acute ischemic stroke imaging" by: "L. Oleaga Zufiria, S. Capurro, L. San Roman, J. Macho, J. Blasco, M. Squarcia, V. Obach, X. Urra; Barcelona/ES"

Xabier Urra

Papers

Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry.

Chronic Traumatic Encephalopathy in a 25-Year-Old Athlete—Distribution of Lesions

After Stroke Are Associated With Worse Outcome'' Letter by Urra et al Regarding Article, ''Autoimmune Responses to the Brain

Acute ischemic stroke imaging