Clinical and laboratory features of the course of COVID-19-associated ischemic stroke with fatal outcome


Professor L. Chichanovskaya, MD; O. Bakhareva, Candidate of Medical Sciences; V. Kosolapova; M. Burova; O. Makarova
Tver State Medical University

Objective. To study clinical and laboratory features of the course of terminal ischemic stroke (IS) associated with COVID-19. Material and methods. We analyzed 23 protocols of pathological examination of patients with IS who died in 2019 (group 1), and 24 protocols of patients with IS who died in 2020–2021. from complications caused by SARS-CoV-2 (group 2). Results. In group 2, a change in the pathogenetic structure of cerebral infarction was revealed, with a predominance of its unspecified variant. In addition, in group 2, males predominated. The average hospitalization time in group 2 was significantly longer compared to group 1. In addition to concomitant diseases (arterial hypertension, chronic heart failure), in group 2 there was a significant increase in both thrombosis of various vascular systems, pneumonia of varying localization and severity, as well as anemia. The general infectious syndrome in patients with IS is a criterion for an unfavorable prognosis, especially if the process of acute-phase inflammation is accompanied by suppression of red blood cells, which can be considered as a marker of an unfavorable course of IS. Conclusion. The combination of IS and COVID-19 forms a new pathogenetic subtype of cerebral infarction with deeper systemic manifestations. It can be assumed that this combination of clinical and laboratory changes is caused not only by massive hypoxia of internal organs, but also by the direct neuropathogenic effect of the virus.

ischemic stroke

  1. Левин О.С., Комарова А.Г., Плоскирева А.А. и др. Особенности течения острого нарушения мозгового кровообращения у пациентов, перенесших новую коронавирусную инфекцию, по данным COVID-центра ГКБ им. С.П. Боткина. РМЖ. 2022; 5: 7–11 [Levin O.S., Komarova A.G., Ploskireva A.A. et al. Patterns of acute cerebrovascular accident in patients who suffered COVID-19, according to the COVID Center of the S.P. Botkin City Clinical Hospital. RMJ. 2022; 5: 7–11 (in Russ.)].
  2. Бахарева О.Н., Бахарева С.А., Конов К.Ю. и др. Неврологические проявления постковидного синдрома и возможности реабилитации. Лазерная медицина. 2021; 25 (1): 16–20 [Bakhareva O.N., Bakharev S.A., Konov K.Y. et al. Neurological manifestations of post-COVID syndrome and possibilities of rehabilitation. Laser Medicine. 2021; 25 (1): 16–20 (in Russ.)]. DOI: 10.37895/2071-8004-2021-25-1-16-20
  3. Мазур Е.С., Мазур В.В., Баженов Н.Д. и др. Особенности тромбоза ушка левого предсердия у больных с персистирующей неклапанной фибрилляцией предсердий, перенесших COVID-19. Кардиология. 2023; 63 (1): 29–35 [Mazur E.S., Mazur V.V., Bazhenov N.D. et al. Features of Left Atrial Appendage Thrombosis in Patients With Persistent Nonvalvular Atrial Fibrillation After COVID-19. Kardiologiia. 2023; 63 (1): 29–35 (in Russ.)]. DOI: 10.18087/cardio.2023.1.n2350
  4. Борисов А. Иммунологические факторы в патогенезе и прогнозировании инсульта. М.: LAP Lambert Academic Publishing, 2018; 292 c. [Borisov A. Immunological factors in the pathogenesis and prognosis of stroke. M.: LAP Lambert Academic Publishing, 2018; 292 p. (in Russ.)].
  5. Бабаев М.А., Петрушин М.А., Дубровин И.А. и др. Острое повреждение миокарда при коронавирусной болезни 2019 (COVID-19) (разбор клинического случая). Клиническая и экспериментальная хирургия. Журнал им. акад. Б.В. Петровского. 2020; 8 (3): 87–94 [Babaev M.A., Petrushin M.A., Dubrovin I.A. et al. Acute myocardial damage with coronavirus disease 2019 (COVID-19) (case study). Clinical and Experimental Surgery. Petrovsky Journal. 2020; 8 (3): 87–94 (in Russ.)]. DOI: 10.33029/2308-1198-2020-8-3-87-94
  6. Воробьев П.А., Момот А.П., Зайцев А.А. и др. Синдром диссеминированного внутрисосудистого свертывания крови при инфекции COVID-19. Терапия. 2020; 6 (5): 25–34 [Vorobyev P.A., Momot A.P., Zaitsev A.A. et al. Disseminated intravascular blood coagulation syndrome in case of COVID-19 infection. Therapy. 2020; 6 (5): 25–34 (in Russ.)]. DOI: 10.18565/therapy.2020.5.25-34
  7. Одинак М.М., Вознюк И.А., Янишевский С.Н. Инсульт. Вопросы этиологии, патогенеза, алгоритмы диагностики и терапии. М.: РГГУ, 2017; 192 c. [Odinak M.M., Voznyuk I.A., Yanishevsky S.N. Stroke. Issues of etiology, pathogenesis, algorithms for diagnosis and therapy. M.: RGGU, 2017; 192 р. (in Russ.)].
  8. Широков Е.А. Инсульт, инфаркт, внезапная смерть: теория сосудистых катастроф. М.: Гостехиздат, 2020; 238 c. [Shirokov E.A. Stroke, Heart Attack, Sudden Death: The Theory of Vascular Accidents. M.: Gostekhizdat, 2020; 238 p. (in Russ.)].