Case Report: COVID-19 Infection and Cervical Artery Dissection

ABSTRACT. A 45-year-old woman presented 3 days after symptom resolution from a COVID-19 infection with a left vertebral artery dissection with no known preceding trauma or underlying disposition. She subsequently suffered a left lateral medullary stroke 15 hours after her initial presentation. Cervical artery dissections (CeAD) can occur in the absence of trauma, and in some cases, infection may be a contributing factor. COVID-19 infection can cause an endotheliopathy and inflammatory response, which may contribute to intimal vessel disruption. Whether COVID-19 infection can contribute to CeAD and subsequent stroke is discussed, along with other considerations regarding the pathogenesis of CeAD.

[1]  M. Raftery,et al.  SARS-CoV-2 in severe COVID-19 induces a TGF-β-dominated chronic immune response that does not target itself , 2021, Nature Communications.

[2]  A. Aslan,et al.  Unilateral common carotid artery dissection in a patient with recent COVID-19: An association or a coincidence? , 2021, Journal of Clinical Neuroscience.

[3]  H. Markus,et al.  Stroke in COVID-19: A systematic review and meta-analysis , 2020, International journal of stroke : official journal of the International Stroke Society.

[4]  G. Gupta,et al.  “COVID-19 and cervical artery dissection- A causative association?” , 2020, Journal of Stroke and Cerebrovascular Diseases.

[5]  Axel Haverich,et al.  Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. , 2020, The New England journal of medicine.

[6]  J. Sejvar,et al.  Neurological associations of COVID-19 , 2020, The Lancet Neurology.

[7]  K. Rejdak,et al.  Non-traumatic cervical artery dissection and ischemic stroke: A narrative review of recent research , 2019, Clinical Neurology and Neurosurgery.

[8]  Tang Tingting,et al.  The TGF-β Pathway Plays a Key Role in Aortic Aneurysms. , 2019, Clinica chimica acta; international journal of clinical chemistry.

[9]  A. Koyfman,et al.  Cervical Artery Dissections: A Review. , 2016, The Journal of emergency medicine.

[10]  H. Dietz,et al.  Loeys–Dietz syndrome: a primer for diagnosis and management , 2014, Genetics in Medicine.

[11]  D. Leys,et al.  Cervical-artery dissections: predisposing factors, diagnosis, and outcome , 2009, The Lancet Neurology.

[12]  D. Leys,et al.  Antiplatelets Versus Anticoagulation in Cervical Artery Dissection , 2007, Stroke.

[13]  B. Conrad,et al.  Elevated inflammatory laboratory parameters in spontaneous cervical artery dissection as compared to traumatic dissection , 2006, Journal of Neurology.

[14]  W. Hacke,et al.  Association of cervical artery dissection with recent infection. , 1999, Archives of neurology.

[15]  R. Gitzelmann,et al.  Ehlers-Danlos syndrome type IV: a multi-exon deletion in one of the two COL3A1 alleles affecting structure, stability, and processing of type III procollagen. , 1988, The Journal of biological chemistry.

[16]  C. Haslett,et al.  Neutrophil-mediated injury to endothelial cells. Enhancement by endotoxin and essential role of neutrophil elastase. , 1986, The Journal of clinical investigation.