COVID-19 can cause cervical arterial dissections or tears in the wall of the large blood vessel in the neck

Medical News: A New Concern Arises from COVID-19 Complications
COVID-19, primarily known for its respiratory symptoms, has continuously revealed its complex and far-reaching effects on the human body. From neurological complications to cardiovascular disruptions, the virus has been associated with an array of health issues. Now, researchers have uncovered yet another alarming concern - cervical arterial dissections, or tears in the large blood vessels in the neck. These tears can lead to serious complications such as strokes, particularly in younger individuals who might not otherwise be considered high-risk.


COVID-19 can cause cervical arterial dissections or tears in the wall of the large blood vessel in the neck

In a significant case report published by researchers from the Department of Neurology at Mayo Clinic in Rochester, Minnesota, six cases of cervical arterial dissections were linked to recent COVID-19 infections. These cases, spanning from 2021 to 2022, offer critical insights into how the virus might predispose individuals to these dangerous vascular injuries. This Medical News report delves into the study’s findings, shedding light on the mechanisms behind these dissections and their implications for public health.
 
What Are Cervical Arterial Dissections?
Cervical arterial dissections occur when a tear forms in the inner lining of an artery in the neck, such as the internal carotid or vertebral arteries. This tear can cause blood to pool and form clots, restricting blood flow to the brain and potentially leading to strokes. While these dissections are relatively rare, they are a significant cause of stroke in younger populations, accounting for 10 - 25% of strokes in individuals under 50 years old.
 
The exact causes of cervical arterial dissections are not always clear, but they have been associated with mechanical trauma, connective tissue disorders, and infections. Now, emerging evidence suggests that COVID-19 may also play a role in triggering these vascular injuries.
 
Case Highlights: Six Patients, Six Stories
The Mayo Clinic researchers presented six cases of cervical arterial dissections in patients who had recently contracted COVID-19. These patients ranged in age from 29 to 74 and had varying medical histories. Four of the cases involved dissections in the internal carotid artery, while two were bilateral vertebral artery dissections. Despite their differences, all six cases shared one common thread - a recent COVID-19 infection.
 
Patient 1: Thunderclap Headache and Vision Loss
A 41-year-old man experienced a sudden, severe headache and temporary vision loss in his right eye. Imaging revealed a complete dissection and occlusion of his right internal carotid artery. The patient responded well to anticoagulant therapy and showed significant improvement over time, though follow-up imaging still indicated partial occlusion.
 
Patient 2: Neck Pain and Pseudoaneurysms
A 42-year-old man developed severe neck pain following prolonged coughing fits during a symptomatic COVID-19 infection. Imaging showed dissections in both internal carotid arteries, accompanied by small pseudoaneurysms. The patient was treated with aspirin and clopidogrel, leading to improved blood flow and healing of the pseudoaneurysms over several months.
 
Patient 3: Stroke Symptoms and Embolic Infarcts
A 74-year-old man presented with stroke-like symptoms, including weakness and facial drooping. Imaging revealed a dissection in the right internal carotid artery and embolic infarcts in the brain. Treated with anticoagulants and aspirin, the patient’s condition stabilized, though imaging later suggested possible fibromuscular dysplasia.
 
Patient 4: Syncopal Event and Dissection
A 44-year-old man experienced a syncopal episode while driving, leading to a mild neck injury. Subsequent imaging revealed a dissection in the left internal carotid artery. He was treated with apixaban and showed significant recovery during follow-up visits.
 
Patient 5: Chiropractic Manipulation Gone Wrong
A 30-year-old woman sought chiropractic treatment for headaches after recovering from COVID-19. During neck manipulation, she developed severe symptoms, including nausea, vertigo, and difficulty speaking. Imaging revealed bilateral vertebral artery dissections. She required urgent endovascular stenting and made a gradual recovery.
 
Patient 6: Neck Cracking Tics and Stroke
A 29-year-old man with autism and a history of neck-cracking tics developed severe neurological symptoms after performing a forceful neck movement. Imaging showed bilateral vertebral artery dissections and a large cerebellar infarct. Although treated with anticoagulants, the patient suffered lasting neurological deficits.
 
The Role of COVID-19 in Cervical Arterial Dissections
The study’s findings suggest that COVID-19 might increase the risk of cervical arterial dissections through several mechanisms. One key factor is the virus’s ability to induce systemic inflammation. COVID-19 is known to trigger a "cytokine storm," characterized by the release of pro-inflammatory molecules such as interleukin-6 (IL-6). These inflammatory signals can weaken arterial walls, making them more susceptible to tears.
 
Additionally, COVID-19 is associated with endothelial dysfunction, a condition that disrupts the inner lining of blood vessels. This dysfunction can impair blood vessel integrity, promoting the formation of clots and arterial dissections. In some cases, mechanical factors such as intense coughing or minor trauma may exacerbate these effects, leading to dissection.
 
Interestingly, one patient in the study showed imaging evidence of an inflammatory process affecting the arteries, further supporting the link between COVID-19-induced inflammation and vascular injury.
 
Treatment and Recovery: A Beacon of Hope
Despite the severity of their conditions, most patients in the study responded well to treatment. Anticoagulants and antiplatelet therapies were the primary treatments, helping to prevent further clot formation and promote healing. Follow-up imaging showed improved blood flow and reduced arterial narrowing in most cases. However, one patient who suffered a major stroke faced long-term neurological challenges.
 
The researchers emphasized the importance of early diagnosis and intervention. Symptoms such as severe neck pain, thunderclap headaches, or stroke-like deficits in the context of recent COVID-19 infections should raise suspicion for cervical arterial dissections. Prompt imaging and treatment can significantly improve outcomes.
 
Implications for Public Health
The link between COVID-19 and cervical arterial dissections highlights yet another dimension of the virus’s impact on health. While these dissections are rare, their potential to cause strokes in younger, otherwise healthy individuals is concerning. This finding underscores the importance of ongoing research into the long-term effects of COVID-19.
 
For healthcare providers, awareness of this complication is crucial. Early recognition and treatment can make a significant difference, preventing life-altering outcomes for affected patients.
 
Conclusion
The Mayo Clinic study adds to a growing body of evidence that COVID-19’s effects extend far beyond the respiratory system. By increasing the risk of cervical arterial dissections through mechanisms such as inflammation and endothelial dysfunction, the virus poses a serious threat to vascular health.
 
Healthcare providers must remain vigilant, particularly when evaluating patients with recent COVID-19 infections who present with symptoms like severe neck pain, headaches, or neurological deficits. Early diagnosis and appropriate treatment can mitigate the risks and improve outcomes.
 
The study findings were published in the peer-reviewed journal: Frontiers in Stroke.
https://www.frontiersin.org/journals/stroke/articles/10.3389/fstro.2024.1366947/full
 
For the latest COVID-19 News, keep on logging to Thailand Medical News.
 
Read Also:
https://www.thailandmedical.news/news/doctors-warn-that-covid-19-can-cause-spontaneous-esophageal-rupture
 
https://www.thailandmedical.news/news/breaking-pediatricians-warn-that-covid-19-can-cause-gastric-perforations-in-new-borns
 
https://www.thailandmedical.news/news/breaking-covid-19-news-case-study-shows-that-even-asymptomatic-sars-cov-2-infections-can-lead-to-spontaneous-bowel-perforations