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. 2020 Sep 1;87(3):E400-E406.
doi: 10.1093/neuros/nyaa254.

Letter: Thrombotic Neurovascular Disease in COVID-19 Patients

Ahmad Sweid  1 , Batoul Hammoud  2 , Joshua H Weinberg  1 , Mazen Oneissi  3   4 , Eytan Raz  5 , Maksim Shapiro  5   6 , Maureen DePrince  1 , Stavropoula Tjoumakaris  1 , Michael R Gooch  1 , Nabeel A Herial  1 , Hekmat Zarzour  1 , Victor Romo  7 , Robert H Rosenwasser  1 , Pascal Jabbour  1
Affiliations

Letter: Thrombotic Neurovascular Disease in COVID-19 Patients

Ahmad Sweid et al. Neurosurgery. .
No abstract available

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Figures

FIGURE 1.
FIGURE 1.
A patient in the seventh decade with a history of A-Fib on eliqus was being treated for COVID-19, and on the 11th day of treatment, the patient developed an acute neurological insult. Tissue plasminogen activator was not given because of anticoagulation, and head computed tomography (CT) did not show hemorrhage. The patient was transferred and underwent a mechanical thrombectomy procedure within 4 h and 18 min. The insult progressed into complete infarct, and the patient passed away 3 d later. A, Noncontrast axial view of brain CT scan showing no hemorrhage. B, Anteroposterior (AP) digital subtraction angiography (DCA) of a right ICA injection showing an M1 and an A2 occlusion. C, AP DCA showing complete revascularization of both vessels (TICI 3). D, Noncontrast axial view of the brain day 1 post mechanical thrombectomy showing the progression of the insult into a complete infarct.
FIGURE 2.
FIGURE 2.
A, Schematic diagram showing CNS access by the SARS-CoV-2 virus through the olfactory nerve. B, Schematic diagram showing CNS access by the SARS-CoV-2 hematogenous route via direct access or via a trojan. The SARS-CoV-2 virus can infect endothelial and glial cells.
FIGURE 3.
FIGURE 3.
Schematic diagram at the level of CNS endothelium showing the SARS-CoV-2 induced ACE2 receptor downregulation. This inhibits the conversion of angiotensin I and II into their active metabolites, Angiotensin (1-9) and Angiotensin (1-7), respectively. The decline in Angiotensin (1-7) levels leads to loss of neuroprotective effects and sympathetic hyperactivity.
FIGURE 4.
FIGURE 4.
Schematic diagram at the level of alveoli showing the SARS-CoV-2 virus binding to ACE2 receptor and infecting the pneumocyte. The immune system is activated, and a cascade of inflammatory reactions leads to a cytokine storm (triggered by an imbalanced response by type 1 and type 2 T helper cells).
See this image and copyright information in PMC

Comment in

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