• Sujan T Reddy, Tanu Garg, Chintan Shah, Fábio A Nascimento, Rajeel Imran, Peter Kan, Ritvij Bowry, Nicole Gonzales, Andrew Barreto, Abhay Kumar, John Volpi, Vivek Misra, David Chiu, Rajan Gadhia, and Sean I Savitz.
• Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA.
• Case Rep Neurol. 2020 May 1; 12 (2): 199-209.

AbstractCOVID-19 has been associated with a hypercoagulable state causing cardiovascular and neurovascular complications. To further characterize cerebrovascular disease (CVD) in COVID-19, we review the current literature of published cases and additionally report the clinical presentation, laboratory and diagnostic testing results of 12 cases with COVID-19 infection and concurrent CVD from two academic medical centers in Houston, TX, USA, between March 1 and May 10, 2020. To date, there are 12 case studies reporting 47 cases of CVD in COVID-19. However, only 4 small case series have described the clinical and laboratory findings in patients with COVID-19 and concurrent stroke. Viral neurotropism, endothelial dysfunction, coagulopathy and inflammation are plausible proposed mechanisms of CVD in COVID-19 patients. In our case series of 12 patients, 10 patients had an ischemic stroke, of which 1 suffered hemorrhagic transformation and two had intracerebral hemorrhage. Etiology was determined to be embolic without a clear cause identified in 6 ischemic stroke patients, while the remaining had an identifiable source of stroke. The majority of the patients had elevated inflammatory markers such as D-dimer and interleukin-6. In patients with embolic stroke of unclear etiology, COVID-19 may have played a direct or indirect role in the processes that eventually led to the strokes while in the remaining cases, it is unclear if infection contributed partially or was an incidental finding.Copyright © 2020 by S. Karger AG, Basel.

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