Clinical and neuroimaging comparisons of acute cerebrovascular accident against the background of ­COVID‑19

Objective — to compare clinical data with the results of neuroimaging methods of brain research in patients with acute cerebrovascular accident against the background of ­COVID‑19. 
Methods and subjects. The medical histories of 72 patients (47 (65.3 %) men and 25 (34.7 %) women) with the diagnosis of acute cerebrovascular accident and coronavirus infection were retrospectively analyzed. In the reception department, all patients with suspected stroke were examined by a neurologist, all patients were examined with a computed tomography scan of the brain, and a smear was taken for polymerase chain reaction (PCR) for ­SARS‑CoV‑2. If necessary, the patient was consulted by a neurosurgeon. Part of the patients underwent MRI. 
Results. Out of 72 patients with appositive PCR test, 46 (63.9 %) had a severe general condition, 26 (36.1 %) had a moderate condition. The average age of patients was 71.7 years (72.2 in men and 70.9 in women). Out‑of‑hospital polysegmental pneumonia developed in 24 (33.3 %) cases. 16 (22.2 %) patients died: (23.4 % of the total number of men) and 5 (20.0 % of the total number of women). According to clinical data and CT data, ischemic stroke developed mainly in the carotid basin (50 (69.4 %) cases): in the left carotid basin (LCB) in 33 cases (45.8 %) and in the right carotid basin (RCB) in 17 cases (23.6 %). In 13 (18.1 %) cases stroke was registered in the vertebrobasilar basin (VBB). According the ST scan and anamnesis, in 6 (8.3 %) cases of accidents in the LCB there were repeated: 5 (6.9 %) — in the VBB (including: left cerebellar hemisphere, right cerebellar hemisphere, right occipital lobe) and in the RCB. In 4 (5.6 %) cases of repeated stroke in the RCB, it was transferred twice to another side of RCB, once to the LCB, and once to the VBB. In all 3 (4.2 %) cases of recurrent stroke in the VBB, it was transferred three times in the carotid basin: twice of the RCB and once to the LCB. 3 patients (4.2 %) were diagnosed with transitional ischemic attack at the VBB (all of them are middle‑aged — 36 — 43 years old). According to CT and clinical data, hemorrhagic stroke was registered in 6 patients (8.3 % of cases). 
Conclusions. Risk factors for the occurrence of HPMC against the background of COVID‑19 are the advanced age and male gender of the patients, as well as the presence of chronic cardiovascular and cerebrovascular diseases. The cases are characterized by a predominant lesion of the large vessels of the left carotid basin, repeated strokes with the appearance of a new focus in another basin, frequent deep lesions in the area of the basal nuclei, as well as background changes in brain tissue during neuroimaging examination. A severe course, complicated by lung and heart failure, prevails, especially when out‑of‑hospital polysegmental, usually bilateral, COVID‑19 pneumonia occurs. 
 