Cryptogenic stroke in a young patient after COVID-19 infection – a case report
DOI:
https://doi.org/10.15584/ejcem.2024.4.31Keywords:
antinuclear antibody, case report, COVID-19, cryptogenic stroke, etiologyAbstract
Introduction and aim. Cryptogenic stroke (CS) is a type of cerebral ischemia in which the cause is unknown or unclear. It can be difficult to determine the cause of CS because of various factors, such as incomplete investigations or the transient or reversible nature of the event. Infections can increase the risk of stroke by causing localized inflammation of the meninges and cerebral parenchyma, systemic inflammation, coagulation, and endothelial dysfunction. COVID-19-related cerebrovascular events can happen due to a hypercoagulable state from systemic inflammation and cytokine storm, post-infectious immune-mediated responses, and direct viral-induced endothelitis, which can lead to angiopathic thrombosis.
Description of the case. A 25-year-old male was diagnosed with mild semantic aphasia. The patient had a history of moderate COVID-19 infection. An angiography revealed that the M2 segment of the middle cerebral artery in the left hemisphere was not contrasted, indicating an occlusion. MRI and CT scans showed evidence of ischemic changes in the left hemisphere of the brain. The patient was treated with several drugs, including antiplatelet and neuroprotective drugs.
Conclusion. Our case demonstrates that autoimmune antibody formation, specifically antinuclear antibodies, can cause vasculopathy, leading to thrombus formation and stroke. It suggests a potential link between autoimmune antibody formation and stroke in COVID-19 patients.
Downloads
References
Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533-534. doi: 10.1016/S1473-3099(20)30120-1
Ntaios G, Michel P, Georgiopoulos G, et al. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke. 2020;51(9):E254-E258. doi: 10.1161/STROKEAHA.120.031208
Siegler JE, Cardona P, Arenillas JF, et al. Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry. Int J Stroke. 2021;16(4):437-447. doi: 10.1177/1747493020959216
Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. doi: 10.1001/jamaneurol.2020.1127
Ellul MA, Benjamin L, Singh B, et al. Neurological associations of COVID-19. Lancet Neurol. 2020;19(9):767-783. doi: 10.1016/S1474-4422(20)30221-0
Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E, et al. Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. Neurology. 2020;95(8):E1060-E1070. doi: 10.1212/WNL.0000000000009937
Saver JL. CLINICAL PRACTICE. Cryptogenic Stroke. N Engl J Med. 2016;374(21):2065-2074. doi: 10.1056/NEJMcp1503946
Fonseca AC, Ferro JM. Cryptogenic stroke. Eur J Neurol. 2015;22(4):618-623. doi: 10.1111/ene.12673
Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke the Helsinki young stroke registry. Stroke. 2009;40(4):1195-1203. doi: 10.1161/STROKEAHA.108.529883
Petty GW, Brown RD, Whisnant JP, Sicks JRD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: A population-based study of incidence and risk factors. Stroke. 1999;30(12):2513-2516. doi: 10.1161/01.STR.30.12.2513
Schulz UGR, Rothwell PM. Differences in vascular risk factors between etiological subtypes of ischemic stroke: Importance of population-based studies. Stroke. 2003;34(8):2050-2059. doi: 10.1161/01.STR.0000079818.08343.8C
Schneider AT, Kissela B, Woo D, et al. Ischemic stroke subtypes: A population-based study of incidence rates among blacks and whites. Stroke. 2004;35(7):1552-1556. doi: 10.1161/01.STR.0000129335.28301.f5
Scullen TA, Monlezun DJ, Siegler JE, et al. Cryptogenic stroke: Clinical consideration of a heterogeneous ischemic subtype. J Stroke Cerebrovasc Dis. 2015;24(5):993-999. doi: 10.1016/j.jstrokecerebrovasdis.2014.12.024
Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP. Effect of medical treatment in stroke patients with patent foramen ovale: Patent foramen ovale in Cryptogenic Stroke Study. Circulation. 2002;105(22):2625-2631. doi: 10.1161/01.CIR.0000017498.88393.44
Bang OY, Lee PH, Joo SY, Lee JS, Joo IS, Huh K. Frequency and mechanisms of stroke recurrence after cryptogenic stroke. Ann Neurol. 2003;54(2):227-234. doi: 10.1002/ana.10644
Collection D. The New England Journal of Medicine RECURRENT CEREBROVASCULAR EVENTS ASSOCIATED WITH PATENT. 2001;345(24):1740-1746.
McNeil BJ, Keeler S, Adelstein SJ. The New England Journal of Medicine Downloaded from nejm.org at HAUPTBIBLIOTHEK UNIV ZUERICH on February 4, 2013. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. All rights re. Published online 1975:2020.
Zhang C, Kasner S. Diagnosis, prognosis, and management of cryptogenic stroke. F1000Research. 2016;5(0):1-6. doi: 10.12688/f1000research.7384.1
Giruparajah M, Bosch J, Vanassche T, et al. Global survey of the diagnostic evaluation and management of cryptogenic ischemic stroke. Int J Stroke. 2015;10(7):1031-1036. doi: 10.1111/ijs.12509
Perera KS, Vanassche T, Bosch J, et al. Global Survey of the Frequency of Atrial Fibrillation-Associated Stroke: Embolic Stroke of Undetermined Source Global Registry. Stroke. 2016;47(9):2197-2202. doi: 10.1161/STROKEAHA.116.013378
Vlachoyiannopoulos PG, Magira E, Alexopoulos H, et al. Autoantibodies related to systemic autoimmune rheumatic diseases in severely ill patients with COVID-19. Ann Rheum Dis. 2020;79(12):1661-1663. doi: 10.1136/annrheumdis-2020-218009
Gazzaruso C, Carlo Stella N, Mariani G, et al. High prevalence of antinuclear antibodies and lupus anticoagulant in patients hospitalized for SARS-CoV2 pneumonia. Clin Rheumatol. 2020;39(7):2095-2097. doi: 10.1007/s10067-020-05180-7
Fujii H, Tsuji T, Yuba T, et al. High levels of anti-SSA/Ro antibodies in COVID-19 patients with severe respiratory failure: a case-based review: High levels of anti-SSA/Ro antibodies in COVID-19. Clin Rheumatol. 2020;39(11):3171-3175. doi: 10.1007/s10067-020-05359-y
Zhou Y, Han T, Chen J, et al. Clinical and Autoimmune Characteristics of Severe and Critical Cases of COVID-19. Clin Transl Sci. 2020;13(6):1077-1086. doi: 10.1111/cts.12805
Yumuk Z. Antinuclear antibodies ( ANA ) in COVID-19 infection. Published online 2021:3-9.
Pascolini S, Vannini A, Deleonardi G, et al. COVID-19 and Immunological Dysregulation: Can Autoantibodies be Useful? Clin Transl Sci. 2021;14(2):502-508. doi: 10.1111/cts.12908
Chang SH, Minn D, Kim YK. Autoantibodies in moderate and critical cases of COVID-19. Clin Transl Sci. 2021;14(5):1625-1626. doi: 10.1111/cts.13036
Sacchi MC, Tamiazzo S, Stobbione P, et al. SARS-CoV-2 infection as a trigger of autoimmune response. Clin Transl Sci. 2021;14(3):898-907. doi: 10.1111/cts.12953
Assar S, Pournazari M, Soufivand P, Mohamadzadeh D. Systemic lupus erythematosus after coronavirus disease-2019 (COVID-19) infection: Case-based review. Egypt Rheumatol. 2022;44(2):145-149. doi: 10.1016/j.ejr.2021.08.013
Sacco RL, Adams R, Albers G, et al. Guidelines for Prevention of Stroke in Patients with Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association Council on Stroke - Co-Sponsored by the Council On 2006;37. doi: 10.1161/01.STR.0000199147.30016.74
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 European Journal of Clinical and Experimental Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
