Stroke in COVID-19 and Pregnancy: A Case Report

Neurological manifestations add prognostic severity to the coronavirus disease (COVID-19). Here, we report a case of a pregnant patient with COVID-19 that progressed with neurological complications. Magnetic resonance imaging revealed cerebral ischemic insults associated with cortical laminar necrosis, in addition to an intraparenchymal brain hematoma. The mechanisms of vascular injury may have multifactorial origins and result in complex radiological presentations. Since stroke associated with pregnancy is one of the main causes of long-term disability in women, accurate identification of cerebrovascular events may potentially reduce sequelae.

Keywords:
Coronavirus infections; Pregnancy; Cerebrovascular accident

Authorship

Mylana Dandara Pereira Gama

Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Recife, PE, Brasil. Universidade de PernambucoBrasilRecife, PE, Brasil Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Recife, PE, Brasil.

http://orcid.org/0000-0001-6895-5848

José Ronaldo Lessa Angelo Júnior

http://orcid.org/0000-0002-4772-3471

Carolina da Cunha-Correia

Universidade de Pernambuco, Faculdade de Ciências Médicas, Departamento de Neurologia, Recife, PE, Brasil.Universidade de PernambucoBrasilRecife, PE, Brasil Universidade de Pernambuco, Faculdade de Ciências Médicas, Departamento de Neurologia, Recife, PE, Brasil.

http://orcid.org/0000-0003-2605-2784

Corresponding author: Mylana Dandara Pereira Gama. e-mail: mylanagama@hotmail.com

Authors´ contribution: CCC conceived the project and collected the initial study data. JRLAJ made contributions to the interpretation of data. MDPG draft the first version of the manuscript, which was critically revised by CCC and JRLAJ. All authors read and approved the final version of the manuscript.

Conflict of Interest: The authors declare no conflict of interest.

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Figures

Figures (2)

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FIGURE 1:
MRI. Axial T2 FLAIR weighted images (A, B). T1-weighted axial images without venous contrast (C) and arterial 3D TOF MRA (D). We noticed hypersignal on T2/FLAIR at the right frontoparietal lobes , with spinning thickening and mild vasogenic edema, corresponding to ischemic arterial vascular injury. There is also cortical spontaneous hypersignal on T1, without expression on T2* images, related to cortical laminar necrosis. There is no mass or reduction on the ADC map on these changes (not shown). We noticed slight signal loss in the proximal segment (M1) of the right middle cerebral artery, in addition to clear asymmetry of its distal segments (M3), with mild vascular poverty to the right (D). MRI, magnetic resonance imaging; FLAIR, fluid-attenuated inversion recovery; MRA, magnetic resonance angiography; 3D TOF, three-dimensional time of flight; ADC, apparent diffusion coefficient

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FIGURE 2:
MRI. T1-weighted axial images (A) and T2*-weighted axial images (B and C). A posterior rounded lesion in in the cingulate gyrus, with spontaneous hypersignal on T1 (A) and hyper with hypointense halo on T2* (B), related to parenchymal hematoma. Control examination shows hematoma in the chronic stage, with reduction in size and marked hypointensity on T2* related to hemosiderin (C). MRI: Magnetic resonance imaging; FLAIR: fluid-attenuated inversion recovery

FIGURE 1: MRI. Axial T2 FLAIR weighted images (A, B). T1-weighted axial images without venous contrast (C) and arterial 3D TOF MRA (D). We noticed hypersignal on T2/FLAIR at the right frontoparietal lobes , with spinning thickening and mild vasogenic edema, corresponding to ischemic arterial vascular injury. There is also cortical spontaneous hypersignal on T1, without expression on T2* images, related to cortical laminar necrosis. There is no mass or reduction on the ADC map on these changes (not shown). We noticed slight signal loss in the proximal segment (M1) of the right middle cerebral artery, in addition to clear asymmetry of its distal segments (M3), with mild vascular poverty to the right (D). MRI, magnetic resonance imaging; FLAIR, fluid-attenuated inversion recovery; MRA, magnetic resonance angiography; 3D TOF, three-dimensional time of flight; ADC, apparent diffusion coefficient

FIGURE 2: MRI. T1-weighted axial images (A) and T2-weighted axial images (B and C). A posterior rounded lesion in in the cingulate gyrus, with spontaneous hypersignal on T1 (A) and hyper with hypointense halo on T2 (B), related to parenchymal hematoma. Control examination shows hematoma in the chronic stage, with reduction in size and marked hypointensity on T2* related to hemosiderin (C). MRI: Magnetic resonance imaging; FLAIR: fluid-attenuated inversion recovery

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Stroke in COVID-19 and Pregnancy: A Case Report

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[1] Corresponding author: Mylana Dandara Pereira Gama. e-mail: mylanagama@hotmail.com