A systematic review on COVID-19 and spinal strokes, the end of an era

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY
Marc Moisi , Christian Bowers , Smit Shah , Sina Zoghi , Carmelo Venero Jr , Shubham Arora , Sara Mirza , Abilash Haridas , Noushin Vahdat , Mina Foroughi , Sadegh Baradaran Mahdavi , Arman Sourani
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引用次数: 0

Abstract

Aim

To investigate the association of the COVID-19 virus with hemorrhagic and ischemic spinal strokes.,

Background

COVID-19 has extensive extrapulmonary manifestations. Myelitis, demyelinating syndromes, hemorrhagic and ischemic presentations have been reported. To date, there is no comprehensive study to delineate an evidence-based correlation between COVID-19 and spinal strokes comprehensively.

Materials and methods

A PRISMA-based systematic review.

Results

In the final review, 8 data sets for ischemia and 11 for hemorrhagic lesions were included.
The mean age for ischemia and hemorrhagic lesions was 52 and 47 years old, respectively. Patients with cord ischemia had more severe COVID-19 pneumonia as compared to hemorrhagic (62 % vs 27 %). Lab results showed 75 % coagulation abnormalities in cord ischemia patients while there was no coagulopathy in the hemorrhage group. Somatosensory deficits were the most prevalent neurological presentations in both groups.
MRI showed that the anterior spinal artery and central ischemia were the most common patterns of COVID-19 spinal ischemia. MRI images also revealed epidural and intramedullary hematomas were the most common type of hemorrhagic lesions with cervical and thoracic preferences.
The most common on-admission neurological status was American Spinal Injury Association (ASIA) impairment scale A-B(ischemia) and ASIA B-D(hemorrhage). All of the ischemic patients received conservative management. In hemorrhagic patients, there were 4 laminectomies, 6 conservative management, and 1 combined approach.
Post-intervention clinical outcomes in ischemia were unfavorable but in the hemorrhagic spinal strokes, it had more promising results.

Conclusion

COVID-19 can cause both ischemia and hemorrhagic spinal strokes. Coagulopathy may be a precipitating factor in cord ischemia development while other neuropathogenesis mechanisms may precipitate spinal hemorrhage. Early surgical or conservative management is the key factor in determining long-term outcomes.
关于COVID-19和脊髓卒中的系统综述,一个时代的终结。
目的:探讨COVID-19病毒与出血性缺血性脑卒中的关系。背景:COVID-19具有广泛的肺外表现。脊髓炎,脱髓鞘综合征,出血性和缺血性表现已被报道。迄今为止,还没有全面的研究全面描述COVID-19与脊髓卒中之间的循证相关性。材料和方法:基于prisma的系统综述。结果:在最后的回顾中,包括8个缺血数据集和11个出血性病变数据集。缺血和出血性病变的平均年龄分别为52岁和47岁。与出血性相比,脊髓缺血患者有更严重的COVID-19肺炎(62%对27%)。实验室结果显示,75%的脊髓缺血患者凝血功能异常,而出血组无凝血功能异常。躯体感觉缺陷是两组中最普遍的神经学表现。MRI显示脊髓前动脉和中枢性缺血是COVID-19脊髓缺血最常见的模式。MRI图像也显示硬膜外血肿和髓内血肿是最常见的出血性病变类型。入院时最常见的神经系统状态是美国脊髓损伤协会(ASIA)损伤量表A-B(缺血)和ASIA B-D(出血)。所有缺血性患者均接受保守治疗。出血患者行椎板切除术4例,保守治疗6例,联合入路1例。干预后的临床结果在缺血中是不利的,但在出血性脊髓卒中中,它有更有希望的结果。结论:COVID-19可引起缺血和出血性脊髓卒中。凝血功能障碍可能是脊髓缺血发展的一个促发因素,而其他神经发病机制可能促发脊髓出血。早期手术或保守治疗是决定长期预后的关键因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Clinical Neuroscience
Journal of Clinical Neuroscience 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
402
审稿时长
40 days
期刊介绍: This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.
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