Acidente vascular cerebral isquêmico submetido a trombólise venosa em paciente Covid-19 positivo: relato de caso / Ischemic stroke submitted to venous thrombolysis in a Covid-19 positive patient: case report
Abstract
A COVID-19 é uma doença multissistêmica que pode variar desde casos assintomáticos até disfunção de múltiplos órgãos. Dentre suas ocorrências possíveis, as manifestações neurológicas chamam atenção pela diversidade de apresentação e gravidade. O objetivo deste relato é abordar o quadro clínico e a investigação etiológica de um caso de AVC isquêmico em paciente infectado por Sars-CoV-2, por meio de análise retroativa de prontuário de M.L.A, sexo masculino, 68 anos, COVID-19 positivo, o qual sofreu AVC isquêmico (AVCI) e foi submetido a trombólise venosa. O Sars-Cov-2 é conhecido por causar sintomas respiratórios de trato respiratório alto e baixo, estimulando a liberação de citocinas inflamatórias (IL-1β e IL-6) por ligação ao Receptor Toll Like (TLR), culminando na Síndrome Respiratória Aguda Grave (SARS). A incidência de AVC em pacientes COVID-19 positivos ainda não é bem determinada. Os eventos isquêmicos agudos incluem déficit cardiovascular, redução da oxigenação, podendo resultar na Síndrome de Angústia Respiratória Aguda, e inflamação sistêmica de efeito pró-tromboembólico. Desse modo, é importante salientar as diversas manifestações sistêmicas da COVID-19.
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ZHANG, Y. Z; HOLMES, E. C. A Genomic Perspective on the Origin and Emergence of SARS-CoV-2. Cell, Sidney, Australia, v. 181, ed. 2, p. 223-227, 16 abr. 2020. DOI https://doi.org/10.1016/j.cell.2020.03.035. Disponível em: https://www.sciencedirect.com/science/article/pii/S0092867420303287?via%3Dihub. Acesso em: 21 ago. 2020.
WHO - World Health Organization. Statement regarding cluster of pneumonia cases in Wuhan, China. China: WHO; 2020. Disponível em: https://www.who.int/china/news/detail/09-01-2020-who-statement-regarding-cluster-of-pneumonia-cases-in-wuhan-china. Acesso em: 4 ago. 2020.
LI , Long-Quan et al. COVID-19 patients‘ clinical characteristics, discharge rate, and fatality rate of meta-analysis. Journal of Medical Virology: Wiley Periodicals, Inc., China, 12 mar. 2020. DOI 10.1002/jmv.25757. Disponível em: https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.25757. Acesso em: 21 ago. 2020.
BRASIL. Ministério da Saúde. Orientações para o manejo de pacientes com COVID, 2020. Brasília, 2020. Disponível em: https://portalarquivos.saude.gov.br/images/pdf/2020/June/18/Covid19-Orientac--o--esManejoPacientes.pdf. Acesso em: 4 ago. 2020
MAO, L et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurology, China, v. 77, ed. 6, p. 683–690, 10 abr. 2020. DOI 10.1001/jamaneurol.2020.1127. Disponível em: https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549. Acesso em: 21 ago. 2020.
YACHOU, Y et al. Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurological Sciences, [s. l.], 28 jul. 2020. DOI 10.1007/s10072-020-04575-3. Disponível em: https://link.springer.com/article/10.1007%2Fs10072-020-04575-3. Acesso em: 21 ago. 2020.
ÖZDAĞ ACARLI, Ayşe Nur et al. Coronavirus Disease 2019 (COVID-19) From the Point of View of Neurologists: Observation of Neurological Findings and Symptoms During the Combat Against a Pandemic. Noro Psikiyatri Arsivi: Archives of Neuropsychiatry, [s. l.], v. 57, ed. 2, p. 154-159, 1 maio 2020. DOI 10.29399/npa.26148. Disponível em: https://europepmc.org/article/med/32550783. Acesso em: 21 ago. 2020.
POYIADJI, Neo et al. COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: Imaging Features. Radiology: RSNA, [s. l.], v. 296, n. 2, 31 mar. 2020. DOI 10.1148/radiol.2020201187. Disponível em: https://pubs.rsna.org/doi/10.1148/radiol.2020201187. Acesso em: 4 ago. 2020.
ZHAO, Hua et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence?. The Lancet: Neurology, [s. l.], v. 19, ed. 5, p. 383-384, 1 abr. 2020. DOI 10.1016/S1474-4422(20)30109-5. Disponível em: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30109-5/fulltext#%20. Acesso em: 1 set. 2020.
MORIGUCHI, Takeshi et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. International Journal of Infectious Diseases: Elsevier, [s. l.], v. 94, p. 55-58, 1 maio 2020. DOI 10.1016/j.ijid.2020.03.062. Disponível em: https://www.ijidonline.com/article/S1201-9712(20)30195-8/fulltext#%20. Acesso em: 4 ago. 2020.
BEYROUT, Rahma et al. Characteristics of ischaemic stroke associated with COVID-19. Journal of Neurology, Neurosurgery & Psychiatry, [s. l.], v. 91, p. 889-891, 30 abr. 2020. DOI 10.1136/jnnp-2020-323586. Disponível em: https://jnnp.bmj.com/content/91/8/889.info. Acesso em: 1 set. 2020.
HOYER, Carolin et al. Acute Stroke in Times of the COVID-19 Pandemic: A Multicenter Study. American Heart Association, [S. l.], ano 2020, p. 2224–2227, 7 jul. 2020. DOI 10.1161/j.bbi.2020.04.077. Disponível em: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030395. Acesso em: 3 ago. 2020.
KLOK, F.A. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research, [S. l.], p. 145-147, 10 abr. 2020. DOI 10.1016/j.thromres.2020.04.013. Disponível em: https://www.thrombosisresearch.com/article/S0049-3848(20)30120-1/fulltext. Acesso em: 3 ago. 2020.
AVULA, Akshay et al. COVID-19 presenting as stroke. Brain, Behavior, and Immunity, [S. l.], v. 87, p. 115-119, 28 abr. 2020. DOI 10.1016/j.bbi.2020.04.077. Disponível em: https://www.sciencedirect.com/science/article/pii/S0889159120306851?via%3Dihub. Acesso em: 4 ago. 2020.
MARKUS, Hugh S; BRAININ, Michael. COVID-19 and stroke - A global World Stroke Organization perspective. International Journal of Stroke, [S. l.], v. 15(4), p. 361–364, 14 abr. 2020. DOI 10.1177/1747493020923472. Disponível em: https://journals.sagepub.com/doi/pdf/10.1177/1747493020923472. Acesso em: 4 ago. 2020.
CO, Christian Oliver C et al. Intravenous Thrombolysis for Stroke in a COVID-19 Positive Filipino Patient, a Case Report. Journal of Clinical Neuroscience , [S. l.], v. 77, p. 234–236, 1 maio 2020. DOI 10.1016/j.jocn.2020.05.008. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32414622/. Acesso em: 4 ago. 2020.
GARG, Ravindra K. Spectrum of Neurological Manifestations in Covid-19: A Review. Neurology India, [S. l.], v. 68, p. 560-572, 6 jul. 2020. DOI 10.4103/0028-3886.289000. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32643664/. Acesso em: 4 ago. 2020.
FARA, Michael G et al. Macrothrombosis and stroke in patients with mild Covid-19 infection. J Thromb Haemost ., [S. l.], v. 18(8), p. 2031-2033, 25 jun. 2020. DOI 0.1111/jth.14938. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32464707/. Acesso em: 5 ago. 2020.
JAIN, Rajan et al. COVID-19 related neuroimaging findings: A signal of thromboembolic complications and a strong prognostic marker of poor patient outcome. Journal of the Neurological Sciences, [S. l.], v. 414, p. 0022-510X, 19 maio 2020. DOI 10.1016/j.jns.2020.116923. Disponível em: https://www.jns-journal.com/article/S0022-510X(20)30260-4/fulltext#articleInformation. Acesso em: 6 ago. 2020.
ARAUJO, Luis Fernando S Castro de et al. Aspectos clínicos e terapêuticos da infecção da COVID-19. In: Rede CoVida: Ciência, Informação e Solidariedade. Covid19br.org, 30 mar. 2020. Disponível em: http://www.isc.ufba.br/wp-content/uploads/2020/03/Aspectos-cl%C3%ADnicos-e-terap%C3%AAuticos-da-infec%C3%A7%C3%A3o-da-COVID-19-1.pdf. Acesso em: 6 ago. 2020.
MASON, Robert J. Pathogenesis of COVID-19 from a cell biology perspective. European Respiratory Journal, [S. l.], ano 2020, v. 55, n. 4, 16 mar. 2020. DOI 10.1183/13993003.00607-2020. Disponível em: https://erj.ersjournals.com/content/55/4/2000607. Acesso em: 7 ago. 2020.
QURESHI, Adnan I. et al. Management of acute ischemic stroke in patients with COVID-19 infection: Insights from an international panel. American Journal of Emergency Medicine, [S. l.], ano 2020, v. 38, p. 1548.e5-1548.e7, 10 maio 2020. DOI 10.1016/j.ajem.2020.05.018. Disponível em: https://www.ajemjournal.com/article/S0735-6757(20)30356-9/fulltext#secst0005. Acesso em: 7 ago. 2020.
PIRES, Sueli Luciano; GAGLIARDI, Rubens José; GORZONI, Milton Luiz. ESTUDO DAS FREQÜÊNCIAS DOS PRINCIPAIS FATORES DE RISCO PARA ACIDENTE VASCULAR CEREBRAL ISQUÊMICO EM IDOSOS. Arq Neuropsiquiatr , São Paulo, ano 2004, v. 62, n. 3-B, p. 844-851, 1 set. 2004. DOI 10.1590/S0004-282X2004000500020. Disponível em: https://www.scielo.br/pdf/anp/v62n3b/a20v623b.pdf. Acesso em: 7 ago. 2020.
HAROLD P. Adams Jr. et al; Classification of Subtype of Acute Ischemic Stroke. Definitions for Use in a Multicenter Clinical Trial. Stroke, Vol24, No1 January, 1993.
Wilson JTL, Harendran A, Grant M, Baird T, Schulz UGR, Muir KW, Bone I. Improving the assessment of outcomes in stroke: Use off a structured interview to assign grades on the modified rankin scale. Stroke. 2002;33:2243-2246.
Choi, Yoon Ji et al; Postoperative excessive blood loss after cardiac surgery can be predicted with the International Society on Thrombosis and Hemostasis scoring system. Volume 67, Issue 5, September–October 2017, Pages 508-515
Manual de Rotinas para Atenção ao AVC. Ministério da Saúde. 1ed, Brasília - DF, 2013
MCA - Alberta stroke program early CT score (ASPECTS) illustration - (modificado). Disponível em https://radiopaedia.org/cases/mca-alberta-stroke-program-early-ct-score-aspects-illustration
Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young: Covid-19 Cases. The New England Journal of Medicine: Correspondence Copyright ©️ 2020 Massachusetts Medical Society., Massachusetts, EUA., v. -, n. -, p. 1-3, 28 abr. 2020. DOI 10.1056/NEJMc2009787. Disponível em: nejm.org.
TANG, Ning, et al. “Abnormal Coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia.” Journal of Thrombosis and Haemostasis (2020).
PAPAGEORGIOU, Chrysoula, et al. “Disseminated intravascular coagulation: an update on pathogenesis, diagnosis, and therapeutic strategies.” Clinical and Applied Thrombosis/Hemostasis 24.9_suppl (2018): 8S-28S.
“Covid-19 ligado a AVC de grandes vasos em jovens adultos”. Medscape- 1 maio,2020. Disponível em https://portugues.medscape.com/verartigo/6504778
BORNSTEIN SR, et al. Practical recommendations for the management of diabetes in patients with Covid-19. Lancet Diabetes Endocrinol. 2020;8:546-50. https://doi.org/10.1016/S2213-8587(20)30152-2
DIRETRIZES PARA TRATAMENTO DA FASE AGUDA DO ACIDENTE VASCULAR CEREBRAL ISQUÊMICO – PARTE II. Comitê Executivo da Sociedade Brasileira de Doenças Cerebrovasculares e Departamento Científico de Doenças Cerebrovasculares da Academia Brasileira de Neurologia. Disponível em: http://www.sbdcv.org.br/documentos/Diretrizes_SBDCV_AVC_Parte2_Portugu%C3%AAs.pdf
Wahlgren N, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet. 2007 Jan 27;369(9558):275-82. doi: 10.1016/S0140-6736(07)60149-4. Erratum in: Lancet. 2007 Mar 10;369(9564):826. PMID: 17258667.
DOI: https://doi.org/10.34119/bjhrv4n2-275
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