Abstract
Introduction: SARS-Corona Virus-2 (SARS-CoV-2/COVID-19) is a novel member of coronaviridae family. This new disease first appeared in China in December 2019, and can cause severe respiratory failure in advanced cases. COVID-19 was announced as a pandemic in March 2020 by WHO. It has infected 76 million people and has caused the death of more than 1.5 million people until December 2020. Common symptoms of this disease are mostly fever, cough, shortness of breath, anosmia, and fatigue. But atypical presentations have also being reported. Here, we present a COVID-19 patient with an unusual neurological symptom. Case: 82-years-old female patient with a history of hypertension and Sheehan’s syndrome came to the emergency room with the complaint of fever, shortness of breath and left hemiplegia. Although nasopharyngeal swab PCR test was negative (twice), acute phase reactants were elevated and chest CT revealed typical findings of COVID-19 pneumonia, so the patient was diagnosed as COVID-19. Since the patient had left hemiplegia, a cranial CT and diffusion-weighted MRI were performed to see whether a central neurological pathology was present. Both imaging revealed the findings of acute ischemic stroke (AIS). Afterwards, the patients was hospitalized and was started on Hydroxychloroquine, acetylsalicylic acid (ASA), favipiravir and methylprednisolone. At the 7th day of follow up, the nasopharyngeal swab PCR test was reperformed and found as positive. On the 10th day of treatment, the symptoms and acute phase reactants regressed. Left hemiplegia of the patient also regressed and she was discharged from the hospital at the 12th day of admission without a sequelae. Discussion and conclusion: Since there has been a recent evidence of strong relationship between COVID-19 and acute ischemic pathologies due to pathophysiology of COVID-19, we should be suspicious of acute ischemic stroke in a COVID-19 patient with neurological symptoms, especially when the patient had a history like Sheehan’s Syndrome disease may aggravate or hide the symptoms.
Highlights
SARS-Corona Virus-2 (SARS-CoV-2/COVID-19) is a novel member of coronaviridae family that first appeared in China in December 2019, causing severe acute respiratory failure [1,2,3]
The severe infectious disease caused by COVID-19 was announced as a pandemic in March 2020 by the WHO
Standard reference test is seen as PCR in the diagnosis of COVID-19, it is stated that Thorax CT can be used in COVID-19 diagnosis by some sources because of the concerns about sensitivity and the fact that PCR test may be false negative / positive [15,16]
Summary
SARS-Corona Virus-2 (SARS-CoV-2/COVID-19) is a novel member of coronaviridae family that first appeared in China in December 2019, causing severe acute respiratory failure [1,2,3]. If the blood loss is severe and especially if it is associated with hypotension, the patient should be evaluated and treated for adrenal insufficiency immediately [9] In this case report, we tried to present a patient with a history of Sheehan’s syndrome, who was diagnosed with COVID-19 and acute stroke concurrently. A 82-years-old female patient with a history of hypertension and Sheehan’s syndrome came to the emergency room with the complaint of fever, shortness of breath and left hemiplegia. On physical examination, her blood pressure was 90/60 mmHg, heartbeat: 95/min spo2: 94 %, and fever: 39.3oC. These findings were compatible with acute ischemic stroke (Figure 2)
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