Bilgin ÖZTÜRK, Ali Rıza SONKAYA, Ömer KARADAŞ

Cerebral hemodynamic alterations in patients with Covid-19

Background/aim: Coronavirus 2019 disease (Covid-19) was first seen in December 2019 and afterwards it became pandemic. Several systemic involvements have been reported in Covid-19 patients. In this study, it was aimed to investigate the cerebrovascular hemodynamics in patients with Covid-19. Materials and methods: The sample of this study included 20 patients hospitalized in our clinic diagnosed with Covid-19 via PCR modality and 20 healthy volunteers of similar age and sex. Bilateral middle cerebral arteries were investigated with transcranial Doppler ultrasonography. Basal cerebral blood flow velocities and vasomotor reactivity rates were determined and statistically compared. Results: When patient and control groups were compared, the mean blood flow velocity was found to be higher in Covid-19 patients than in the healthy volunteers and it was statistically significant (P = 0.00). The mean vasomotor reactivity rates values were found to be lower in the Covid-19 group than the healthy group and was also statistically significant (P = 0.00). Conclusion: An increase in basal cerebral blood velocity and a decrease in vasomotor reactivity rates in patients with Covid-19 can be considered as an indicator of dysfunction of cerebral hemodynamics in the central nervous system and this can be evaluated as a result of endothelial dysfunction.Key words: Covid-19, SARS-Cov-2, blood flow velocity, vasomotor reactivity

PDF

___

1. Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T et al. A novel coronavirus associated with severe acute respiratory syndrome. New England journal of medicine. 2003; 348 (20): 1953-1666. doi: 10.1056/NEJMoa030781
2. Kuiken T, Fouchier RA, Schutten M, Rimmelzwaan GF, Van Amerongen G et al. Newly discovered coronavirus as the primary cause of severe acute respiratory syndrome. The Lancet 2003; 362 (9380): 263-270. doi: 10.1016/S0140-6736(03)13967- 0
3. Drosten C, Günther S, Preiser W, Van Der Werf S, Brodt H-R et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. New England Journal of Medicine 2003; 348 (20): 1967-1976. doi: 10.1056/NEJMoa030747
4. De Groot RJ, Baker SC, Baric RS, Brown CS, Drosten C et al. Commentary: Middle East respiratory syndrome coronavirus (MERS-CoV): announcement of the Coronavirus Study Group. Journal of Virology 2013; 87 (14): 7790-7792. doi: 10.1128/JVI.01244-13
5. Zhou F, Yu T, Du R, Fan G, Liu Y et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet 2020; 395: 1054-1062. doi: 10.1016/S0140-6736(20)30566-3
6. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323 (13): 1239-1242. doi: 10.1001/jama.2020.2648
7. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Annals of Internal Medicine 2020; 172 (9): 577- 582. doi:10.7326/M20-0504
8. Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses 2020; 12 (1): 14. doi: 10.3390/v12010014
9. Bohmwald K, Galvez N, Ríos M, Kalergis AM. Neurologic alterations due to respiratory virus infections. Frontiers in Cellular Neuroscience 2018; 12: 386. doi: 10.3389/ fncel.2018.00386
10. Trujillo H, Caravaca-Fontán F, Sevillano Á, Gutiérrez E, Caro J et al. SARS-CoV-2 infection in hospitalized patients with kidney disease. Kidney International Reports 2020; 5 (6): 905- 909. doi: 10.1016/j.ekir.2020.04.024
11. Colavita F, Lapa D, Carletti F, Lalle E, Bordi L et al. SARS-CoV-2 isolation from ocular secretions of a patient with COVID-19 in Italy with prolonged viral RNA detection. Annals of Internal Medicine 2020; 173 (3): 242-243. doi: 10.7326/M20-1176
12. Cheung KS, Hung IF, Chan PP, Lung K, Tso E et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis. Gastroenterology 2020; 159 (1): 81-95. doi: 10.1053/j.gastro.2020.03.065
13. Galván Casas C, Català A, Carretero Hernández G, Rodríguez‐ Jiménez P, Fernández Nieto D et al. Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology 2020 183: 3-4. doi: 10.1111/bjd.19163
14. Albina G, Fernandez Cisneros L, Laino R, Nobo UL, Ortega D et al. Transcranial Doppler monitoring during head upright tilt table testing in patients with suspected neurocardiogenic syncope. Europace 2004; 6 (1): 63-69. doi: 10.1016/j. eupc.2003.09.009
15. Cencetti S, Bandinelli G, Lagi A. Effect of PCO2 changes induced by head-upright tilt on transcranial Doppler recordings. Stroke 1997; 28 (6): 1195-1197. doi: 10.1161/01. str.28.6.1195
16. Heckmann JG, Hilz MJ, Hagler H, Muck-Weymann M, Neundijrfer B. Transcranial Doppler sonography during acute 80° head-down tilt (HOT) for the assessment of cerebral autoregulation in humans. Neurological Research 1999; 21 (5): 457-462. doi: 10.1080/01616412.1999.11740959
17. Paulson O, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovascular and Brain Metabolism Reviews 1990; 2 (2): 161-192.
18. Carey BJ, Manktelow BN, Panerai RB, Potter JF. Cerebral autoregulatory responses to head-up tilt in normal subjects and patients with recurrent vasovagal syncope. Circulation 2001; 104 (8): 898-902.doi: 10.1161/hc3301.094908
19. Newel DW AR. Transcranial Doppler. 1st ed. New York, NY, USA: Raven Press; 1992.
20. Uzuner N. İntrakranyal aterosklerozisde ultrasonografi. Turkish Journal of Neurology 2004; 2 (2): 62-63.
21. Ornello R, Frattale I, Caponnetto V, Pistoia F, Sacco S. Cerebral vascular reactivity and the migraine-stroke relationship: a narrative review. Journal of the Neurological Sciences 2020; 414: 116887. doi: 10.1016/j.jns.2020.116887
22. Ozturk B, Karadas Ö. Cerebral Hemodynamic Changes During Migraine Attacks and After Triptan Treatments. Archieves of Neuropsychiatry 2019.doi: 10.29399/npa.21650
23. Portegies MLP, BruijnRFAGd, Hofman A, Koudstaal PJ, Ikram MA. Cerebral vasomotor reactivity and risk of mortality. Stroke 2014; 45 (1): 42-47. doi: 10.1161/STROKEAHA.113.002348
24. Ju K, Zhong L, Ni X, Cao H, Cheng G, Ding L. Cerebral vasomotor reactivity predicts the development of acute stroke in patients with internal carotid artery stenosis. Neurologiai Neurochirurgia Polska 2018; 52 (3): 374-378. doi: 10.1016/j. pjnns.2017.12.015
25. Mamontov OV, Kozlenok AV, Kamshilin AA, Shlyakhto EV. The autonomic regulation of circulation and adverse events in hypertensive patients during follow-up study. Cardiology Research and Practice 2019: 8391924. doi: 10.1155/2019/8391924
26. Klok FA, Kruip M, Van der Meer NJM, Arbous MS, Gommers D et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research 2020; 191: 145-147. doi: 10.1016/j.thromres.2020.04.013
27. Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Translational Research 2020; 220: 1-13. doi: 10.1016/j.trsl.2020.04.007
28. Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M et al. High risk of thrombosis in patients with severe SARSCoV-2 infection: a multicenter prospective cohort study. Intensive Care Medicine 2020; 46 (6): 1089-1098. doi: 10.1007/ s00134-020-06062-x
29. Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T et al. Pulmonary embolism in COVID-19 patients: awareness of an increased prevalence. Circulation 2020; 142 (2):184-186. doi: 10.1161/CIRCULATIONAHA.120.047430
30. Llitjos JF, Leclerc M, Chochois C, Monsallier JM, Ramakers M et al. High incidence of venous thromboembolic events in anticoagulated severe COVID‐19 patients. Journal of Thrombosis and Haemostasis 2020; 18 (7): 1743-1746. doi: 10.1111/jth.14869
31. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID‐19. Journal of Thrombosis and Haemostasis 2020; 18 (7): 1559-1561. doi: 10.1111/jth.14849
32. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H et al. Largevessel stroke as a presenting feature of Covid-19 in the young. New England Journal of Medicine 2020; 382 (20): e60. doi: 10.1056/NEJMc2009787
33. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R et al. Endothelial cell infection and endotheliitis in COVID-19. The Lancet 2020; 395 (10234): 1417-1418. doi: 10.1016/S0140- 6736(20)30937-5
34. Flammer AJ, Anderson T, Celermajer DS, Creager MA, Deanfield J et al. The assessment of endothelial function: from research into clinical practice. Circulation 2012; 126 (6): 753- 767. doi: 10.1161/CIRCULATIONAHA.112.093245
35. Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arteriosclerosis, Thrombosis, and Vascular Biology 2003; 23 (2): 168-175. doi: 10.1161/01. ATV.0000051384.43104.FC