Türk Beyin Damar Hast Derg. 2022; 28(1): 23-30 | DOI: 10.5505/tbdhd.2022.27879

COVID-19 hastalarýnda iskemik inme: Tek merkezin bir yýllýk tecrübesi

Taylan Altýparmak¹, Can Çubuk¹, Hazal Selvi Çubuk^2
1Çankýrý Devlet Hastanesi, Nöroloji Bölümü
²Çankýrý Devlet Hastanesi, Radyoloji Bölümü

GÝRÝÞ ve AMAÇ: COVÝD-19’un klinik özellikleri deðiþkenlik göstermektedir. Hastalýk sýklýkla solunum sistemi semptomlarý ile prezente olmakla birlikte hastalýðýn inflamatuar doðasý sonucu tromboembolik olaylar da tetiklenebilmektedir. Çalýþmamýzda bir yýl içerisinde merkezimizde taný alan ve COVÝD-19 ile birliktelik gösteren iskemik inme hastalarýnýn klinik özelliklerini tanýmlamayý amaçladýk.
YÖNTEM ve GEREÇLER: Kliniðimizde bir yýl boyunca iskemik serebrovasküler hastalýk tanýsý konulan toplam 258 hasta geriye dönük olarak tarandý. Bu hastalarýn klinik, laboratuar ve görüntüleme bulgularý retrospektif olarak deðerlendirildi. Toplam 25 hasta COVÝD-19 tanýsý almýþ olup, çalýþmaya dahil edilmiþtir.
BULGULAR: Hastalardan 18'inin COVID-19 RT-PCR sonucu pozitif olarak, 7'sinin ise negatif olmasýna raðmen toraks BT'lerinde tipik COVID-19 pnömoni bulgularý olmasý nedeniyle klinik ve radyolojik olarak taný konulmuþtur. Hastalarýn çoðunluðunda anterior dolaþýmda, geniþ damar oklüzyonu sonucu enfarkt oluþumu gözlenmiþtir. En sýk eþlik eden hastalýklar hipertansiyon (%56), diyabet (%44) ve atriyal fibrilasyon (%44) olarak belirlenmiþtir. On üç hastada kardiyoembolizm, 9 hastadaysa ateroskleroz inme etyolojisi olarak tespit edilmiþtir. NIHSS skoru 10’un üzerinde olan 14 hastadan 13’ü mortal seyretmiþtir. CRP (13/25), D-Dimer (15/25) ve Ferritin (14/25) düzeyleri yüksek olan hastalarda mRS>3 bulunmuþtur. Hastalarýn çoðunda (19/ 25) Toraks BT görüntüleme bulgusu CORADS 5 olarak deðerlendirilmiþtir. Taburculuk döneminde iki hastada mRS 4-5, 9 hastada mRS 0-3 þeklindedir. Toplamda 14 hasta ise mortal seyretmiþtir.
TARTIÞMA ve SONUÇ: Prognozu belirlemede önemli parametrelerden biri ilk deðerlendirmedeki NIHSS skorlarý olduðu düþünülmektedir. Ayrýca, ileri yaþ, kadýn cinsiyet, beyin görüntülemede geniþ damar oklüzyonu varlýðý, yüksek CRP, Ferritin, D-dimer seviyeleri, COVID-19 RT-PCR pozitifliði, hipertansiyon ve atriyal fibrilasyon komorbiditeleri olan hastalarýn prognozu kötü seyretmiþtir.

Anahtar Kelimeler: COVID-19, iskemik inme, COVID-19 reporting and data system (CO-RADS), National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS).

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Ischemic stroke in COVID- 19 patients: Single center, one year experience

Taylan Altýparmak¹, Can Çubuk¹, Hazal Selvi Çubuk^2
1Cankiri State Hospital, Neurology Department
²Cankiri State Hospital, Radiology Department

INTRODUCTION: The clinical presentation of COVID-19 varies greatly. Even though, disease cause predominantly respiratory manifestations, because of the inflammatory nature of the disease, it also triggers thromboembolic conditions. We aim to describe the features of COVID-19 positive ischemic stroke patients of 1-year experiences of a single center.
METHODS: A total of 258 patients, diagnosed with ischemic cerebrovascular disease (25 patients of with strokes had respiratory symptoms at initial presentation and COVID-19 diagnosis), were evaluated retrospectively during the study period.
RESULTS: A majority of these patients strokes were in anterior circulation territory and most of them were large vessel occlusion. Eighteen of the patients had positive COVID-19 RT-PCR results, while 7 of the patients had negative results but their thorax CTs made the diagnosis of COVID-19. Hypertension (56%), diabetes (44%), and atrial fibrillation (44%) were the most comorbidities. Thirteen patients stroke etiology was cardioembolism, 9 had atherosclerosis. Fourteen of the patients NIHSS were >10, and 13 of them died. Patients with high levels of CRP (13/25), D-Dimer (15/25) and Ferritin (14/25) had mRS>3 at admission. Most of the patients (19/ 25) had CO- RADS 5 scores at admission. Two patients had mRS 4-5, 9 patients had mRS 0-3 at the discharge period. Fourteen patients died at the hospital period.
DISCUSSION AND CONCLUSION: The admission NIHSS scores determined significantly the prognosis. Moreover, higher age, women gender, LVO in neuroimagining, high CRP, Ferritin, D-dimer levels, COVID-19 RT-PCR positivity, presence of hypertension and atrial fibrillation comorbidities showed poor outcome.

Keywords: COVID-19, ischemic stroke, COVID-19 reporting and data system (CO-RADS), National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS).

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