Search

Résumé: Nous rapportons le cas d'une patiente présentant un accident vasculaire cérébral (AVC) ischémique, secondaire à un thrombus de la carotide interne, sur plaque d'athérome. La taille du thrombus et son association à une embolie pulmonaire sont inhabituels et le seul facteur favorisant potentiel identifié est le contexte de Covid-19, sans signe de gravité de l'infection. La survenue de volumineuses thromboses artérielles au cours de la maladie liée au coronavirus est largement rapportée depuis le début de l'épidémie. Ce phénomène, responsable notamment d'AVC ischémiques sévères, ne survient pas nécessairement chez des patients présentant une forme grave de l'infection, mais semble associé à un moins bon pronostic fonctionnel. We report a case of ischemic stroke characterized by unusual large thrombosis of the internal carotid, origin associated to pulmonary embolism in a patient without any prothrombotic factor except from mild signs of Covid-19. The high incidence of thrombotic phenomens observed among patients with coronavirus during the last months does not seem to systematically occur among patients with severe presentation of the infection, but seems associated to a worst functional prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common inherited cerebral small vessel disease and is a cause of early onset ischemic lacunar stroke. COVID-19 infection may lead, in addition to acute respiratory syndrome, to vascular complications including stroke. Herein, we report three CADASIL patients presenting with cerebral border-zone infarcts concomitant to COVID-19 infection and summarize similar cases previously published in literature., Methods: Clinical and radiological features of the 3 patients were collected and described. A narrative review of literature was performed in PubMed and Google Scholar by the end of 2022 using the "CADASIL" AND "COVID-19" AND "stroke" terms., Results: In our 3 patients, aged 40-58 years, stroke symptoms occurred one to 11 days after the first COVID-19 manifestations. Pulmonary symptoms were mild or absent. One patient presented with hemodynamic failure presumably related to acute cardiomyopathy. Brain magnetic resonance imaging revealed in all cases, ischemic lesions within border-zone areas in both cerebral hemispheres, lesions in the genu of the corpus callosum or in the medium cerebellar peduncles in two cases. The watershed pattern of ischemic lesions was detected in two cases despite any blood pressure drop or severe respiratory dysfunction. Seven CADASIL patients presenting with acute brain infarcts (multiple in 4/7) in context of SARS-CoV-2 infection were identified in literature, despite no fall in blood pressure except for one of them., Conclusion: Our observations, in line with previous reports, further suggest that COVID-19 infection may alter blood flow autoregulation in the deepest cerebral white matter in CADASIL patients. The thrombocytopathy and endotheliopathy developing during COVID-19 infection may participate to the underlying vascular processes., (© 2023 The Author(s). Published by S. Karger AG, Basel.)