RESUMO
Although the pathophysiology of coagulopathy associated with the 2019 coronavirus disease (COVID-19) is not well known, occurrence of pulmonary embolism (PE) is frequently observed. However, few cases have been described in the literature in which patients who had asymptomatic COVID-19, with no risk factors for venous thromboembolism (VTE), presented extensive acute PE. We report the case of a patient with asymptomatic COVID-19, complicated by deep vein thrombosis and later by extensive acute PE, suggesting that these conditions should be systematically considered, even in asymptomatic COVID-19 patients with no known risk factors for VTE.
RESUMO
BACKGROUND: A variety of neurological manifestations have been attributed to COVID-19. OBJECTIVE: To investigate the occurrence of neurological symptoms and neuroimaging findings in patients hospitalized in two Brazilian reference centers. METHODS: We performed a retrospective cohort study of patients who had laboratory-confirmed COVID-19 presenting in two hospitals in Brazil between March 4 and July 7, 2020, who underwent brain imaging. RESULTS: We recorded 1,359 patients with laboratory-confirmed COVID-19. Brain imaging was performed in 250 (18.4%) patients with neurological symptoms, and nine of them (3.6%) had acute or subacute ischemic stroke neuroimaging findings. Six of the nine patients initially presented with respiratory symptoms while the other three patients presented to the emergency room with acute stroke signs. CONCLUSIONS: We described the neuroimaging findings of patients infected with COVID-19 who presented with neurological symptoms in two major hospitals in Brazil. We reinforce the importance of being aware of cerebrovascular complications, both in severe hospitalized patients and in patients who present to the emergency room with acute neurological symptoms, even in the elderly.
Assuntos
COVID-19 , Acidente Vascular Cerebral , Idoso , Brasil/epidemiologia , Humanos , Neuroimagem/métodos , Estudos Retrospectivos , SARS-CoV-2 , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologiaRESUMO
ABSTRACT Background: A variety of neurological manifestations have been attributed to COVID-19. Objective: To investigate the occurrence of neurological symptoms and neuroimaging findings in patients hospitalized in two Brazilian reference centers. Methods: We performed a retrospective cohort study of patients who had laboratory-confirmed COVID-19 presenting in two hospitals in Brazil between March 4 and July 7, 2020, who underwent brain imaging. Results: We recorded 1,359 patients with laboratory-confirmed COVID-19. Brain imaging was performed in 250 (18.4%) patients with neurological symptoms, and nine of them (3.6%) had acute or subacute ischemic stroke neuroimaging findings. Six of the nine patients initially presented with respiratory symptoms while the other three patients presented to the emergency room with acute stroke signs. Conclusions: We described the neuroimaging findings of patients infected with COVID-19 who presented with neurological symptoms in two major hospitals in Brazil. We reinforce the importance of being aware of cerebrovascular complications, both in severe hospitalized patients and in patients who present to the emergency room with acute neurological symptoms, even in the elderly.
RESUMO Introdução: Diversas manifestações neurológicas têm sido atribuídas à COVID-19. Objetivo: Investigar a ocorrência de sintomas neurológicos e achados de neuroimagem em pacientes internados em dois centros de referência brasileiros. Métodos: Estudo retrospectivo que avaliou pacientes internados em dois hospitais no Brasil entre 4 de março e 7 de julho de 2020, com confirmação laboratorial de infecção pelo COVID-19 e que foram submetidos a tomografia computadorizada ou ressonância magnética do crânio em razão de sintomas neurológicos. Resultados: Obtivemos 1.359 pacientes com confirmação laboratorial de infecção pelo COVID-19. Deles, 250 (18,4%) apresentaram sintomas neurológicos e foram submetidos a exames de imagem do crânio e nove (3,6%) demonstraram achados de neuroimagem compatíveis com acidente vascular cerebral (AVC) isquêmico agudo ou subagudo. Em seis dos nove pacientes, observaram-se inicialmente tosse e dispneia graves, enquanto outros três chegaram ao pronto-socorro com sinais de AVC agudo. Conclusões: Foram descritos os achados de neuroimagem em pacientes infectados com COVID-19 em dois grandes centros de referência brasileiros. Reforçamos a importância de estar atento aos quadros neurológicos, especialmente de AVC, tanto em pacientes graves hospitalizados quanto em pacientes que chegam ao pronto-socorro com sintomas neurológicos agudos, mesmo em idosos.
RESUMO
Resumo Apesar de a fisiopatologia da coagulopatia associada à doença do coronavírus 2019 (COVID‐19) não ser bem conhecida, a ocorrência de embolia pulmonar (EP) é frequentemente observada. No entanto, foram descritos na literatura poucos casos de pacientes que tiveram COVID-19 oligossintomática, sem nenhum fator de risco para tromboembolismo venoso (TEV) e que apresentaram EP aguda extensa. Relatamos um caso de paciente com COVID-19 oligossintomática, complicada por trombose venosa profunda e, posteriormente, EP aguda extensa, sugerindo que esses quadros devem ser considerados de forma sistemática mesmo em pacientes com COVID-19 oligossintomática e sem fatores de risco conhecidos para TEV.
Abstract Although the pathophysiology of coagulopathy associated with the 2019 coronavirus disease (COVID-19) is not well known, occurrence of pulmonary embolism (PE) is frequently observed. However, few cases have been described in the literature in which patients who had asymptomatic COVID-19, with no risk factors for venous thromboembolism (VTE), presented extensive acute PE. We report the case of a patient with asymptomatic COVID-19, complicated by deep vein thrombosis and later by extensive acute PE, suggesting that these conditions should be systematically considered, even in asymptomatic COVID-19 patients with no known risk factors for VTE.