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SAO PAULO – With the growing perception that the Sars-CoV-2 coronavirus causes neurological changes and may cause the formation of microcoagulants in blood vessels, doctors who are at the forefront of the fight against the pandemic are beginning to fear an increase in the cases. of covid-19 related stroke. Some hospitals are already studying protocol changes for these patients to investigate whether they have the virus.
The concern has been taking shape with the increase in reports by doctors from other countries about these cases. This Saturday, the American newspaper The Washington Post published a report in which professionals at Mount Sinai Beth Israel Hospital in New York report an increase in healthy patients between 30 and 40 years who suffered a stroke, in which the presence of the coronavirus was subsequently identified.
Chinese researchers have previously published observational, case series-type studies with covid-19 patients who had a stroke, and similar reports have been made by Spanish doctors, but have not yet been sent to scientific publications.
The State He listened to neurologists from some hospitals in São Paulo and Rio and identified the occurrence of at least three similar situations, but that still need further investigation. However, the expectation of doctors is that this scenario will become more evident in the coming weeks, when the epidemic reaches its peak.
Neurologist Gabriel Freitas, a researcher at the D’Or Research and Education Institute (IDOR) and the Universidade Federal Fluminense, says he had a patient who came to the hospital with a stroke, without other symptoms, and then with a chest tomography it was noted that he had the covid. Another case of a small stroke, which he attended in the office, was also positive for the coronavirus.
“We have talked a lot with neurologists from Spain and there it was very clear. At the most critical moment of the epidemic, they saw many people arrive with a stroke and, when investigated, they also had covid. The stroke was the first manifestation of the disease. They also had patients already hospitalized with covid who had a stroke later, “says Freitas.
The researcher comments that the case reports in the United States also coincide with the peak of the epidemic in the country, which generates the alert that in the next two weeks we can have a similar image in Brazil.
Because of this, he states that the care protocol for these patients is changing in at least two hospitals, Quinta D’Or and Copa D’Or, and this implementation is being discussed throughout the D’OR network. “The recommendation now for every patient who comes in with a stroke is to have it investigated by covid, with chest tomography and testing, and to be treated as such until proven otherwise,” he says.
Gisele Sampaio, coordinator of Rede Brasil AVC and neurologist at the Albert Einstein Hospital and Escola Paulista de Medicina, also claims to have received a case of stroke in a 56-year-old patient who later proved to be a covid-19 as well. “She went to the hospital with a severe headache, she had breathing problems, she was tired, so we did a lung scan. We saw the pattern compatible with covid, then confirmed it with a PCR test. We imagine it is related to covid, yes … because I didn’t have another important stroke history, “says Gisele. The patient ended up dying.
According to the doctor, the Brazilian societies of cerebrovascular disease and neurointervention are preparing a document with recommendations for stroke patients to be investigated by covid.
“There is great potential for these patients to be asymptomatic from a respiratory point of view, but they can transmit it not only to other patients but also to health professionals. Medical societies in the United States and Europe have made this recommendation and we will do so. also: that each patient who arrives with a stroke, be treated like a covid until he has the result, “he says.
Disorders in the coagulation process.
The main suspicion is that this occurs because the coronavirus appears to cause disturbances in the coagulation process. Necropsies in victims of the disease revealed the presence of small clots in the blood vessels of different parts of the body. Thrombosis in the lungs has also been observed, and the hypothesis is that some of these thrombi may reach the brain.
The pathologist Paulo Saldiva, from the USP School of Medicine and coordinator of the group that performs autopsies on patients who died at the Hospital das Clínicas, says that in 18 bodies analyzed, he found brain injuries in two using CT scans. “These are suggestive signs that may be due to recent strokes, but we have not yet done a microscopic analysis of the material collected in the brain,” he says.
In addition to the clotting problem, there are indications that covid also causes other neurological changes. “There are already reports in the medical literature about delirium, behavioral changes, bleeding, as well as stroke,” says Viviane Cordeiro Veiga, UCI coordinator at the Portuguese Charity of São Paulo. “Countless situations are being described, but are still initial reports,” he says.
She says she has yet to receive any stroke and covid-19 patients, as well as neurologist Eli Faria Evaristo of Sírio, but both say they hope to see this when the epidemic reaches its peak.
“It is still hypothesized that covid is the cause of stroke cases in the United States, but the virus has been found in several necropsy analyzes worldwide to have the property of inducing thrombosis in the lung. It is reasonable admitting that this action is favorable avid thrombosis can cause thrombosis in other organs. The Department of Cardiology has also suggested an increase in heart attacks, “says Evaristo.
According to the doctor, there has not yet been an official change in the protocol for treating Sirius, but doctors are aware of the symptoms. “And since a head CT scan is mandatory, it doesn’t take much running the machine to the lung to see if there is any compromise. It is not a protocol yet, but it is increasing.”
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