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Occam’s Razor, Stroke, and COVID-19

Occam’s Razor, Stroke, and COVID-19 LETTERS e read with great interest the article by Goldberg et al while neglecting the complexity of the diagnosis of a thrombo- Wreporting a case of coronavirus 2019 (COVID-19)–related philic stateinduced by thepresenceofantiphospholipidantibody cerebral infarcts in a 64-year-old man with hypertension and evi- and anticardiolipin immunoglobulin (aPL). For example, these dence of mild, diffuse atherosclerotic disease on brain and neck aPLs should be persistent (at medium/high titer on$ 2consecutive imaging. They concluded that manifestations of COVID-19 are occasions at least 12 weeks apart) to have a pathogenic role. Indeed, not limited to the respiratory system and that neuroradiologists the laboratory data they reportedfitswellintothe sphere of an should be aware of the associated cerebrovascular disease and its unspecific laboratory sign of a sepsis, as often occurs without any potential underlying etiologies. pathologic relevance. The hypothesis made that associated activa- We should like to make some comments on this, in the hope tion of immune and inflammatory pathways led to plaque disrup- that they may be of use. tion and was a source of thrombosis (indeed, probably a free- Piacenza was the second most heavily hit Italian city by floating thrombus) is not supported by further instrumental investi- COVID-19. This allowed http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

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Publisher
American Journal of Neuroradiology
Copyright
© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A6656
Publisher site
See Article on Publisher Site

Abstract

LETTERS e read with great interest the article by Goldberg et al while neglecting the complexity of the diagnosis of a thrombo- Wreporting a case of coronavirus 2019 (COVID-19)–related philic stateinduced by thepresenceofantiphospholipidantibody cerebral infarcts in a 64-year-old man with hypertension and evi- and anticardiolipin immunoglobulin (aPL). For example, these dence of mild, diffuse atherosclerotic disease on brain and neck aPLs should be persistent (at medium/high titer on$ 2consecutive imaging. They concluded that manifestations of COVID-19 are occasions at least 12 weeks apart) to have a pathogenic role. Indeed, not limited to the respiratory system and that neuroradiologists the laboratory data they reportedfitswellintothe sphere of an should be aware of the associated cerebrovascular disease and its unspecific laboratory sign of a sepsis, as often occurs without any potential underlying etiologies. pathologic relevance. The hypothesis made that associated activa- We should like to make some comments on this, in the hope tion of immune and inflammatory pathways led to plaque disrup- that they may be of use. tion and was a source of thrombosis (indeed, probably a free- Piacenza was the second most heavily hit Italian city by floating thrombus) is not supported by further instrumental investi- COVID-19. This allowed

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Aug 1, 2020

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