Reversible cerebral vasoconstriction syndrome and dissection in the setting of COVID-19 infection

Abstract

The current COVID-19 pandemic has recently brought to attention the myriad of neuro- logic sequelae associated with Coronavirus infection including the predilection for stroke, particularly in young patients. Reversible cerebral vasoconstriction syndrome (RCVS) is a well-described clinical syndrome leading to vasoconstriction in the intracra- nial vessels, and has been associated with convexity subarachnoid hemorrhage and oc- casionally cervical artery dissection. It is usually reported in the context of a trigger such as medications, recreational drugs, or the postpartum state; however, it has not been described in COVID-19 infection. We report a case of both cervical vertebral ar- tery dissection as well as convexity subarachnoid hemorrhage due to RCVS, in a pa- tient with COVID-19 infection and no other triggers.

Keywords: COVID-19; Convexity subarachnoid hemorrhage; Coronavirus,; Reversible cerebral vasoconstriction syndrome; Vertebral artery dissection.

Fig. 1

CT brain on admission demonstrates bilateral convexity subarachnoid hemorrhage (A); diagnostic cerebral angiogram on admission demonstrates a left vertebral artery dissection (B), also seen on CT angiogram (C).

Fig. 2

Diagnostic cerebral angiogram at one week demonstrates bilateral diffuse vasoconstriction in the anterior circulation, as measured on angiographic images.

Fig. 3

3-dimensional rotational imaging shows left anterior cerebral artery and middle cerebral artery vasospasm in the M3 segment.