CoChat
Sign Up
Cited by 280Long-Term Effects of COVID-19COVID-19 Clinical Research StudiesAcute Ischemic Stroke Management

The DOI matches its Crossref record; 45 of the 47 references it cites were found in a registry or an index.

Cerebrovascular disease in patients with COVID-19: neuroimaging, histological and clinical description

Open access
Hernández-Fernández, Francisco, Sandoval Valencia, Hernán, Barbella-Aponte, Rosa Angélica, Collado-Jiménez, Rosa, Ayo-Martín, Óscar, Barrena, Cristina, Molina-Nuevo, Juan David, García-García, Jorge, Lozano-Setién, Elena, Alcahut-Rodriguez, Cristian, Martínez-Martín, Álvaro, Sánchez-López, Antonio, Segura, Tomás·2020·Brain
DOI 10.1093/brain/awaa239PMC PMC7454411
Open this paper in CoChat — free accountOpen PDF

Abstract

Since the appearance of the first case of coronavirus disease 2019 (COVID-19) a pandemic has emerged affecting millions of individuals worldwide. Although the main clinical manifestations are respiratory, an increase in neurological conditions, specifically acute cerebrovascular disease, has been detected. We present cerebrovascular disease case incidence in hospitalized patients with SARS-CoV-2 infection. Patients were confirmed by microbiological/serological testing, or on chest CT semiology. Available data on co-morbidity, laboratory parameters, treatment administered, neuroimaging, neuropathological studies and clinical evolution during hospitalization, measured by the modified Rankin scale, were analysed. A bivariate study was also designed to identify differences between ischaemic and haemorrhagic subtypes. A statistical model of binary logistic regression and sensitivity analysis was designed to study the influence of independent variables over prognosis. In our centre, there were 1683 admissions of patients with COVID-19 over 50 days, of which 23 (1.4%) developed cerebrovascular disease. Within this group of patients, cerebral and chest CT scans were performed in all cases, and MRI in six (26.1%). Histological samples were obtained in 6/23 cases (two brain biopsies, and four arterial thrombi). Seventeen patients were classified as cerebral ischaemia (73.9%, with two arterial dissections), five as intracerebral haemorrhage (21.7%), and one leukoencephalopathy of posterior reversible encephalopathy type. Haemorrhagic patients had higher ferritin levels at the time of stroke (1554.3 versus 519.2, P = 0.004). Ischaemic strokes were unexpectedly frequent in the vertebrobasilar territory (6/17, 35.3%). In the haemorrhagic group, a characteristic radiological pattern was identified showing subarachnoid haemorrhage, parieto-occipital leukoencephalopathy, microbleeds and single or multiple focal haematomas. Brain biopsies performed showed signs of thrombotic microangiopathy and endothelial injury, with no evidence of vasculitis or necrotizing encephalitis. The functional prognosis during the hospital period was unfavourable in 73.9% (17/23 modified Rankin scale 4-6), and age was the main predictive variable (odds ratio = 1.5; 95% confidence interval 1.012-2.225; P = 0.043). Our series shows cerebrovascular disease incidence of 1.4% in patients with COVID-19 with high morbidity and mortality. We describe pathological and radiological data consistent with thrombotic microangiopathy caused by endotheliopathy with a haemorrhagic predisposition.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/brain/awaa239

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

Flagged first, then by citations

Show all 47 references

2 of the 47 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Items 201–278 of 278

Related

See all

Metadata

Authors
Hernández-Fernández, F., Sandoval Valencia, H., Barbella-Aponte, R. A., Collado-Jiménez, R., Ayo-Martín, Ó., Barrena, C., Molina-Nuevo, J. D., García-García, J., Lozano-Setién, E., Alcahut-Rodriguez, C., Martínez-Martín, Á., Sánchez-López, A., & Segura, T.
Affiliations
  • Department of Neurology, Hospital General Universitario de Albacete, Albacete, Spain
  • Department of Neurosurgery, Hospital General Universitario de Albacete, Albacete, Spain
  • Hospital General Universitario de Albacete (ES)
  • Department of Radiology, Hospital General Universitario de Albacete, Albacete, Spain
  • Anaesthesia Intensive Care Unit, Hospital General Universitario de Albacete, Albacete, Spain
ORCID
Venue
Brain
Publisher
Oxford University Press (OUP)
Published
2020-07-09
Volume
143
Issue
10
Pages
3089-3103
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
DOI
10.1093/brain/awaa239
PMC
PMC7454411
OpenAlex
W3041271257
Cited by
280
References
47
Citations by year
2026: 5 · 2025: 11 · 2024: 20 · 2023: 41 · 2022: 48 · 2021: 105 · 2020: 49
FWCI
26.29
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • Brain (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Keywords
COVID-19 pandemic, SARS-CoV-2, cerebrovascular disease, stroke, ischemic stroke, intracerebral hemorrhage, posterior circulation stroke, cerebral microbleeds, subarachnoid hemorrhage, leukoencephalopathy, posterior reversible encephalopathy syndrome, thrombotic microangiopathy, endothelial injury, ferritin, brain biopsy, arterial thrombus, age as prognostic factor
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, Age Factors, Aged, Brain, Cerebral Hemorrhage, Brain Ischemia, Female, Ferritins, Humans, Magnetic Resonance Imaging, Male, Pneumonia, Viral, Spain, Tomography, X-Ray Computed, Comorbidity, Incidence, Coronavirus Infections, Leukoencephalopathies, Pandemics, Neuroimaging

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review