Neuroimaging in COVID-19 Patients on Mechanical Ventilation Receiving Sedation: Insight Beyond Diagnosis: A Case Series

Pachipala Sudheer, Ayush Agarwal, V. Vishnu, A. Pandit, D. Vibha, R. Bhatia, M. Srivastava
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Abstract

Patients with severe COVID-19 are at risk of thrombotic complications such as deep vein thrombosis, pulmonary thromboembolism, myocardial infarction, and stroke. The incidence of strokes following COVID-19 is reported to be around 1.2%. There has been increased incidence with COVID-19 of large vessel strokes, especially in young patients without any known vascular risk factors. We reported four patients with severe COVID-19-associated acute respiratory distress syndrome where stroke was diagnosed following neuroimaging. All the patients were on ventilatory assistance and supportive treatment when stroke was diagnosed. They had received sedation and paralytics during mechanical ventilation. Poor response to stimulation and nonresponsiveness after wearing off sedation prompted neuroimaging in these patients, which revealed stroke. Incidentally, all these patients had hypernatremia when stroke was diagnosed. This case series suggests that stroke should be considered a possible cause in all COVID-19 patients presenting with abnormal or altered sensorium.
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接受镇静的机械通气患者的神经影像学:诊断之外的洞察:一个病例系列
重症COVID-19患者有发生血栓性并发症的风险,如深静脉血栓形成、肺血栓栓塞、心肌梗死和中风。据报道,COVID-19后中风的发病率约为1.2%。COVID-19大血管卒中的发病率有所增加,特别是在没有任何已知血管危险因素的年轻患者中。我们报告了4例与covid -19相关的严重急性呼吸窘迫综合征患者,他们在神经影像学检查后被诊断为中风。所有患者在诊断为中风时均给予呼吸辅助和支持治疗。他们在机械通气期间接受了镇静和麻痹。在这些患者中,对刺激的不良反应和镇静失效后的无反应促使神经影像学检查显示中风。顺便说一句,所有这些患者在被诊断为中风时都有高钠血症。这一系列病例表明,在所有表现出异常或感觉改变的COVID-19患者中,卒中应被视为可能的病因。
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