Vessel wall magnetic resonance imaging in COVID‐19‐associated cryptogenic ischemic stroke

• Published in: European journal of neurology Vol. 29; no. 2; pp. 615 - 619
• Main Authors: Mazzacane, Federico, Zito, Antonio, Magno, Serena, Persico, Alessandra, Mazzoleni, Valentina, Asteggiano, Carlo, Rognone, Elisa, Pichiecchio, Anna, Padovani, Alessandro, Cavallini, Anna, Morotti, Andrea
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.02.2022; John Wiley and Sons Inc
• Subjects: Aged; Brain Ischemia - complications; Brain Ischemia - diagnostic imaging; cerebrovascular; Coronaviruses; COVID-19; Diagnostic systems; Etiology; Female; Humans; Inflammation; Ischemia; Ischemic Stroke; Magnetic Resonance Imaging; Male; Medical imaging; Resonance; SARS-CoV-2; Short Communication; Stroke; Stroke - diagnostic imaging; Stroke - etiology; undetermined stroke; vasculitis; Viral diseases; vwMRI; cerebrovascular; SARS-CoV-2; undetermined stroke; vasculitis; vwMRI
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.15128

Background and purpose Acute ischemic stroke (AIS) is a common complication of coronavirus disease 2019 (COVID‐19), but the underlying biological mechanisms remain unclear. We aimed to describe the prevalence of vessel wall alterations in patients with cryptogenic stroke through vessel wall magnetic resonance imaging (vwMRI). Methods All consecutive patients admitted for AIS and COVID‐19 to a single neuro‐COVID unit from 10 November to 31 December 2020 were prospectively evaluated and underwent a complete etiologic workup for AIS. In patients with cryptogenic stroke, the diagnostic workup was completed with vwMRI study. Results After the exclusion of four patients ineligible for MRI, a total of 10 patients were included (median age = 78 years, 50% males), of whom four (40%) had a cryptogenic stroke. vwMRI showed vascular changes consistent with inflammation of intracranial artery walls in three subjects (75%). Two patients had focal and one multifocal involvement. Conclusions vwMRI detected signs of vascular inflammation in the majority of patients with cryptogenic AIS, leading to an etiologic definition with potential therapeutical implications. Our findings are best interpreted as hypothesis‐generating, suggesting the possibility of expanding the diagnostic workup of cryptogenic stroke with vessel wall imaging. Acute ischemic stroke (AIS) is a common complication of coronavirus disease 2019 (COVID‐19), and a high frequency of cryptogenic events has been reported. In these cases, a possible underlying inflammatory etiology has been proposed. Vessel wall magnetic resonance imaging detected signs of vascular inflammation in the majority of patients with COVID‐19‐associated cryptogenic AIS, suggesting its inclusion in the diagnostic workup of these patients.