Objective

To report six consecutive patients with confirmed coronavirus disease-2019 (COVID-19) who underwent Transcranial Doppler (TCD) ultrasonography evaluation for cerebral microemboli in the setting of suspected or confirmed acute ischemic stroke.

Methods

Patient data were obtained from medical records from Northwestern Memorial Hospital, Chicago, IL between May and June 2020. All patients with confirmed COVID-19 who underwent clinical TCD ultrasonography for microemboli detection were included.

Results

A total of eight TCD studies were performed in six patients with COVID-19 (4 men and 2 women, median age 65±5), four with confirmed ischemic stroke and two with refractory encephalopathy. Microemboli were detected in three male patients, two patients had suffered a confirmed ischemic stroke and one who developed prolonged encephalopathy. Microemboli of varying intensity were identified in multiple vascular territories in two patients, and microemboli persisted despite therapeutic anticoagulation in a third patient. Of the three patients without evidence of microemboli on TCD ultrasonography, two patients had suffered a confirmed ischemic stroke, while one remained with refractory encephalopathy.

Conclusions

TCD ultrasonography for microemboli detection identified three patients with confirmed COVID-19 with evidence of cerebral arterial microemboli, including one who was therapeutically anticoagulated. TCD ultrasonography provides a non-invasive method for evaluating cerebral microemboli in patients with COVID-19 and may be useful in assessing response to treatment in cases with suspected or confirmed disorders of hypercoagulability. Further studies investigating the prevalence of cerebral microemboli and associated risk factors are needed to characterize their pathogenic mechanism and guide therapeutic interventions in hospitalized COVID-19 patients.

中文翻译：

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COVID-19 中主动脑栓塞的经颅多普勒超声证据

客观的

报告连续 6 例确诊为 2019 冠状病毒病 (COVID-19) 的患者，这些患者在疑似或确诊急性缺血性卒中的情况下接受了经颅多普勒 (TCD) 超声评估脑微栓子。

方法

患者数据来自伊利诺伊州芝加哥西北纪念医院 2020 年 5 月至 6 月的医疗记录。所有确诊 COVID-19 并接受临床 TCD 超声检查以检测微栓子的患者均被纳入。

结果

共对 6 名 COVID-19 患者（4 名男性和 2 名女性，中位年龄 65±5 岁）、4 名确诊为缺血性卒中的患者和 2 名患有难治性脑病的患者进行了 8 项 TCD 研究。在三名男性患者中检测到微栓子，两名患者确诊为缺血性中风，一名患者出现长期脑病。在两名患者的多个血管区域发现了不同强度的微栓子，尽管在第三名患者中进行了抗凝治疗，但微栓子仍然存在。在 TCD 超声检查未发现微栓子证据的三名患者中，两名患者确诊为缺血性卒中，而另一名患者仍患有难治性脑病。

结论

用于微栓子检测的 TCD 超声检查确定了三名确诊为 COVID-19 且有脑动脉微栓子证据的患者，其中一名患者接受了抗凝治疗。TCD 超声检查为评估 COVID-19 患者的脑微栓子提供了一种非侵入性方法，可能有助于评估疑似或确诊高凝状态患者的治疗反应。需要进一步研究脑微栓塞的患病率和相关的危险因素，以表征其致病机制并指导住院 COVID-19 患者的治疗干预。