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Acute cerebrovascular disease, especially isomoric stroke, has become a serious complication of COVID-19.
, the mechanism and best treatment are not yet fully clear.
in the lungs and heart circulation, there is limited evidence that complications of thrombosis may be associated with endothion inflammation and injury.
We have demonstrated that direct imaging evidence of angiotisols in patients with multiple COVID-19s responds to isotope strokes inhibited by steroids and targeted white melebin-1 (IL-1) and interlethional-6 (IL-6).
64-year-old man with type 2 diabetes, high blood pressure, hypercholesterolemia and is ishemia heart disease was admitted to hospital with a five-day history of dry cough and fever.
patients diagnosed with COVID-19 pneumonia require early intination, mechanical aeration, positive muscle support and blood filtration to treat acute kidney injury.
blood tests showed lymphocyte reduction (0.6 x 109 / L), elevated C-reactive protein (196 mg / L), renal insfusy (creatinine 156 mol/L) and elevated D-dipolymers ( sgt; 20,000 sg/ L).
, and because he needed ongoing renal replacement therapy, the patient was systemic heparinized.
nasopharyngeal swab reverse transcriptase PCR test confirmed SARS-CoV-2 infection.
24th day of hospitalization, after sedation, there was no proper response to the proclonic tyclonic movement of the near-end upper limbs.
patients are taking aspirin and intravenous heparin at this time.
MRI brain shows abnormal signals of left and right top lobes, pillows and temporal lobes, variable limited diffusion, and outer weekly enhancement (Figure 1).
appearance is consistent with multiple subacute infarctions in the right central brain artery (MCA) and two post-brain arteries (PCA) regions.
magnetic resonance angiotomy shows right PCA and left PCA closure.
comparison of volume T1 SPACE MRI sequences showed long segments, commonary abnormalities, MCA, an artery of the forebrain (ACA), vertebral arteries and the strengthening of the vascular wall of the substrate arteries (Figure 1).
appearance suggests diffuse intracranial angioarthritis and multiple area infarctions.
virological screening showed previous evidence of hepatitis C virus (no viral RNA detected in the blood) and chickenpox shingles virus infection, but no signs of active infection.
enterovirus, hepatitis B and HIV serology are all negative.
anti-nuclei (ANA), anti-neutral granulocyte plasma (ANCA) and antiphospholipid antibodies are negative.
the patient was given intravenous meth nylon (1 μg per day for 3d days) and then oral python (60 mg per day).
was given zoaceta for treatment of seizures.
have been prescribed axiowe and cephalosporine on an empirical basis.
six days later showed that the patient spontaneously opened his eyes, had no fixed, complete brain-dry reflexes, and withdrew painful stimuli.
was discussed in a multidisciplinary way, including the potential impact of initial positive hepatitis C serology, with two delabeling tests of il-1 subject antagonist anakinra at a dose of 200 mg per day.
MRI examination on the 42nd day of hospitalization (the 5th day of anakinra treatment) did not reveal new infarctions, reduced brain swelling and persistent abnormal vascular wall enhancement.
neurologic improvements have been observed, and patients are now located for pain stimulation.
in view of the negative hepatitis C virus RNA test, the biological therapy was changed to intravenous IL-6 antagonist tocilizumab 8 mg/kg, repeated every 4 weeks.
neurological assessment three days later (day 47) showed that the patient was able to obey orders, utter a word and sit down to get up, further improving the condition.
, the patient's condition continued to improve with AKI's treatment and successful weaning of the air.
imaging examination on the 57th day showed evidence of a therapeutic response, including the disappearance of abnormal MCA and ACA vascular wall enhancement (Figure 1) and a decrease in vertebral substrate artery vascular wall enhancement.
is not yet certain of the best treatment interventions for COVID-19-related cerebrovascular diseases.
these early findings, in addition to treatments that address endothy infections and viral replication, can also reduce endoskin inflammation through reasonable trials.
in the authors' cases, the trial of recombinant IL-1 antagonist anakinra was considered reasonable because of its potential neuro protective effects and early evidence of therapeutic benefits in other COVID-19-related vasculitis syndromes.
COVID-19-related cases of intracranial angiotis, clinical and radiological evidence of therapeutic responses to steroid therapy and IL-1 and IL-6 pathway antagonists has further increased the potential benefits of immunosuppression, and there is an urgent need to explore the possible benefits of anticytokine drugs and antiviral therapies.
this.
Dixon L, Coughlan C, Karunaratne K, et al Immunosuppression for intracranial vasculitis associated with SARS-CoV-2: therapeutics for COVID-19o pathvascular Journalology of Neurology, Neurosurgery and Psimology Published Online First: 27 August 2020. doi: 10.1136/jnnp-2020-324291MedSci Original Source: MedSci Original Copyright Statement: All notes on this website "Source: Met Medical" or "Source: MedSci Original" Images and audio-visual materials, copyrighted by Metz Medical, are not authorized to be reproduced by any media, website or individual and must be reproduced with the reference "Source: Metz Medicine".
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