Thrombectomy of an Acute Ischemic Stroke in a Child with COVID-19 and MIS-C: Case Analysis and Literature Context
Abstract
:1. Introduction
2. Case Presentation
3. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Ahmed, M.; Advani, S.; Moreira, A.; Zoretic, S.; Martinez, J.; Chorath, K.; Acosta, S.; Naqvi, R.; Burmeister-Morton, F.; Burmeister, F.; et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine 2020, 26, 100527. [Google Scholar] [CrossRef]
- Rimensberger, P.C.; Kneyber, M.C.J.; Deep, A.; Bansal, M.; Hoskote, A.; Javouhey, E.; Jourdain, G.; Latten, L.; MacLaren, G.; Morin, L.; et al. Caring for Critically Ill Children with Suspected or Proven Coronavirus Disease 2019 Infection: Recommendations by the Scientific Sections’ Collaborative of the European Society of Pediatric and Neonatal Intensive Care. Pediatr. Crit. Care Med. 2021, 22, 56–67. [Google Scholar] [CrossRef] [PubMed]
- Feldstein, L.R.; Rose, E.B.; Horwitz, S.M.; Collins, J.P.; Newhams, M.M.; Son, M.B.F.; Newburger, J.W.; Kleinman, L.C.; Heidemann, S.M.; Martin, A.A.; et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N. Engl. J. Med. 2020, 383, 334–346. [Google Scholar] [CrossRef] [PubMed]
- Hennon, T.R.; Penque, M.D.; Abdul-Aziz, R.; Alibrahim, O.S.; McGreevy, M.B.; Prout, A.J.; Schaefer, B.A.; Ambrusko, S.J.; Pastore, J.V.; Turkovich, S.J.; et al. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach. Prog. Pediatr. Cardiol. 2020, 57, 101232. [Google Scholar] [CrossRef] [PubMed]
- Hennon, T.R.; Yu, K.O.A.; Penque, M.D.; Abdul-Aziz, R.; Chang, A.C.; McGreevy, M.B.; Pastore, J.V.; Prout, A.J.; Schaefer, B.A.; Alibrahim, O.S.; et al. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; revisiting the Western New York approach as the pandemic evolves. Prog. Pediatr. Cardiol. 2021, 62, 101407. [Google Scholar] [CrossRef] [PubMed]
- Jiang, L.; Tang, K.; Levin, M.; Irfan, O.; Morris, S.K.; Wilson, K.; Klein, J.D.; Bhutta, Z.A. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect. Dis. 2020, 20, e276–e288. [Google Scholar] [CrossRef] [PubMed]
- Libby, P.; Luscher, T. COVID-19 is, in the end, an endothelial disease. Eur. Heart J. 2020, 41, 3038–3044. [Google Scholar] [CrossRef] [PubMed]
- LaRovere, K.L.; Riggs, B.J.; Poussaint, T.Y.; Young, C.C.; Newhams, M.M.; Maamari, M.; Walker, T.C.; Singh, A.R.; Dapul, H.; Hobbs, C.V.; et al. Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome. JAMA Neurol. 2021, 78, 536–547. [Google Scholar] [CrossRef] [PubMed]
- Appavu, B.; Deng, D.; Dowling, M.M.; Garg, S.; Mangum, T.; Boerwinkle, V.; Abruzzo, T. Arteritis and Large Vessel Occlusive Strokes in Children After COVID-19 Infection. Pediatrics 2021, 147, e2020023440. [Google Scholar] [CrossRef]
- Chang, J.; Bulwa, Z.; Breit, H.; Cherian, L.J.; Conners, J.J.; Song, S.Y.; Dafer, R.M. Acute Large Vessel Ischemic Stroke in Patients With COVID-19-Related Multisystem Inflammatory Syndrome. Pediatr. Neurol. 2022, 126, 104–107. [Google Scholar] [CrossRef]
- Graham, E.L.; Koralnik, I.J.; Liotta, E.M. Therapeutic Approaches to the Neurologic Manifestations of COVID-19. Neurotherapeutics 2022, 19, 1435–1466. [Google Scholar] [CrossRef] [PubMed]
- Dimitriadis, K.; Meis, J.; Neugebauer, H.; Barlinn, K.; Neumann, B.; Gahn, G.; Lochner, P.; Knier, B.; Lindemann, S.; Suhs, K.W.; et al. Neurologic manifestations of COVID-19 in critically ill patients: Results of the prospective multicenter registry PANDEMIC. Crit. Care 2022, 26, 217. [Google Scholar] [CrossRef] [PubMed]
- Beslow, L.A.; Linds, A.B.; Fox, C.K.; Kossorotoff, M.; Zuniga Zambrano, Y.C.; Hernandez-Chavez, M.; Hassanein, S.M.A.; Byrne, S.; Lim, M.; Maduaka, N.; et al. Pediatric Ischemic Stroke: An Infrequent Complication of SARS-CoV-2. Ann. Neurol. 2021, 89, 657–665. [Google Scholar] [CrossRef]
- LaRovere, K.L.; Poussaint, T.Y.; Young, C.C.; Newhams, M.M.; Kucukak, S.; Irby, K.; Kong, M.; Schwartz, S.P.; Walker, T.C.; Bembea, M.M.; et al. Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs. 2020. JAMA Neurol. 2023, 80, 91–98. [Google Scholar] [CrossRef] [PubMed]
- Tiwari, L.; Shekhar, S.; Bansal, A.; Kumar, S. COVID-19 associated arterial ischaemic stroke and multisystem inflammatory syndrome in children: A case report. Lancet Child Adolesc. Health 2021, 5, 88–90. [Google Scholar] [CrossRef] [PubMed]
- Parikh, T.; Goti, A.; Yashi, K.; Gopalakrishnan Ravikumar, N.P.; Parmar, N.; Dankhara, N.; Satodiya, V. Pediatric Sickle Cell Disease and Stroke: A Literature Review. Cureus 2023, 15, e34003. [Google Scholar] [CrossRef]
- Ezetendu, C.; Baloglu, O.; Othman, H.F.; Nandakumar, V.; Latifi, S.; Aly, H. Stroke in pediatric ECMO patients: Analysis of the National Inpatient Sample (NIS) database. Pediatr. Res. 2022, 92, 754–761. [Google Scholar] [CrossRef]
- Gulko, E.; Overby, P.; Ali, S.; Mehta, H.; Al-Mufti, F.; Gomes, W. Vessel Wall Enhancement and Focal Cerebral Arteriopathy in a Pediatric Patient with Acute Infarct and COVID-19 Infection. AJNR Am. J. Neuroradiol. 2020, 41, 2348–2350. [Google Scholar] [CrossRef]
- Mirzaee, S.M.M.; Goncalves, F.G.; Mohammadifard, M.; Tavakoli, S.M.; Vossough, A. Focal Cerebral Arteriopathy in a Pediatric Patient with COVID-19. Radiology 2020, 297, E274–E275. [Google Scholar] [CrossRef]
- Spence, J.D.; de Freitas, G.R.; Pettigrew, L.C.; Ay, H.; Liebeskind, D.S.; Kase, C.S.; Del Brutto, O.H.; Hankey, G.J.; Venketasubramanian, N. Mechanisms of Stroke in COVID-19. Cerebrovasc. Dis. 2020, 49, 451–458. [Google Scholar] [CrossRef]
- Gonzalez-Gonzalez, F.J.; Ziccardi, M.R.; McCauley, M.D. Virchow’s Triad and the Role of Thrombosis in COVID-Related Stroke. Front. Physiol. 2021, 12, 769254. [Google Scholar] [CrossRef] [PubMed]
- Zhang, S.; Zhang, J.; Wang, C.; Chen, X.; Zhao, X.; Jing, H.; Liu, H.; Li, Z.; Wang, L.; Shi, J. COVID-19 and ischemic stroke: Mechanisms of hypercoagulability (Review). Int. J. Mol. Med. 2021, 47, 21. [Google Scholar] [CrossRef] [PubMed]
TEST | RESULT | REFERENCE |
---|---|---|
HEMATOLOGY | ||
WBC (neutrophils per mm3) | 22.56 (18.26) | 4–12 |
Absolute lymphocytes (per L) | 1.9 × 109 | 1.50–7.00 |
Platelet count—per mm3 | 442 | 150–450 |
SERUM CHEMISTRY | ||
AST-SGOT (units per L) | 50 | <40 |
NT-proBNP (pg/mL) | 36,163 | 0.00–125.00 |
Ferritin (ng/mL) | 3736 | 30.0–400.0 |
Triglyceride (mg/dL) | 222 | 0–75 |
INFLAMMATORY MARKERS | ||
CRP (mg/dL) | 16.96 | 0.00–0.50 |
Procalcitonin (ng/mL) | 12.40 | 0.00–0.05 |
SARS-CoV-2 PCR | Detected | |
SARS-CoV-2 Ab, IgM/IgG | Reactive | |
Influenza A and B rapid | Negative | |
Blood culture at 96 h | No growth | |
IL 2 receptor (pg/mL) | 23,183.8 | 175.3–958.2 |
IL 10 (pg/mL) | 228.1 | ≤2.1 |
IL 13 (pg/mL) | 13.9 | ≤2.3 |
IL 17 (pg/mL) | 4.6 | ≤1.4 |
IL 8 (pg/mL) | 11.7 | ≤2.0 |
IL 6 (pg/mL) | 41.9 | ≤3.0 |
TNF alpha (pg/mL) | 12.5 | ≤7.2 |
HEMOSTASIS | ||
Prothrombin Time (s) | 14.7 | 12.4–14.4 |
d-Dimer (mcg/mL) | 3.81 | 0.00–0.50 |
THROMBOPHILIA PANEL | ||
Factor V Leiden mutation | Heterozygous | |
MTHFR mutation | Not detected | |
PT 202101G>A mutation | Not detected | |
AT III | 96 units/dL | |
Protein C activity | 137% | |
Protein S activity | 71% |
Patient [Source] | Age (Years) | Sex | NIHSS | LAO | Endo Rx | MIS-C | Causative Dx | Outcome |
---|---|---|---|---|---|---|---|---|
1 [9] | 8 | Girl | 15 | LMCA | Yes | No | Arteritis | Ambulating with walker and minimal assistance around day 30 (mRS = 4) |
2 [9] | 16 | Boy | 19 | LMCA | No | No | Arteritis | Aphasia and right hemiparesis around day 60 (mRS = 3) |
3 [10] | 15 | Girl | 15 | LMCA (pd) | No | Yes | LVD | No deficit at 30 days |
4 [10] | 16 | Girl | 16 | LICA (t) | No | Yes | LVT | Independent but aphasic at 41 days |
5 [Ours] | 3 | Boy | LMCA (md) | Yes | Yes | Factor V Leiden | Essentially normal at 30 days |
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Carney, P.R.; Stevenson, D.W.; Riggs, E.; Dervisevic, M.; Carney, C.X.; Gomez, C.R. Thrombectomy of an Acute Ischemic Stroke in a Child with COVID-19 and MIS-C: Case Analysis and Literature Context. Children 2023, 10, 851. https://doi.org/10.3390/children10050851
Carney PR, Stevenson DW, Riggs E, Dervisevic M, Carney CX, Gomez CR. Thrombectomy of an Acute Ischemic Stroke in a Child with COVID-19 and MIS-C: Case Analysis and Literature Context. Children. 2023; 10(5):851. https://doi.org/10.3390/children10050851
Chicago/Turabian StyleCarney, Paul R., Dakota W. Stevenson, Edith Riggs, Matilda Dervisevic, Constanza X. Carney, and Camilo R. Gomez. 2023. "Thrombectomy of an Acute Ischemic Stroke in a Child with COVID-19 and MIS-C: Case Analysis and Literature Context" Children 10, no. 5: 851. https://doi.org/10.3390/children10050851
APA StyleCarney, P. R., Stevenson, D. W., Riggs, E., Dervisevic, M., Carney, C. X., & Gomez, C. R. (2023). Thrombectomy of an Acute Ischemic Stroke in a Child with COVID-19 and MIS-C: Case Analysis and Literature Context. Children, 10(5), 851. https://doi.org/10.3390/children10050851