COVID-19 Positive Stroke Patient With Large Vessel Occlusion in the Epidemic.

Gönül Akdağ,Muhammed Alperen Bardakçı,Mustafa Cetiner,Güngör Çakmakçı,Sibel Canbaz Kabay

doi:10.7759/cureus.19848

Abstract

COVID-19 disease causes various neurological disorders. Of these, stroke is the most devastating and difficult to manage in epidemic conditions. An increase in the rate of acute ischemic stroke in hospitalized coronavirus patients and stroke with large vessel occlusion due to COVID-19 disease have been reported in recent publications. The management of these patients is difficult and becomes even more challenging in epidemic conditions. A 71-year-old man suddenly developed left-sided weakness while he was hospitalized for COVID-19 disease. Cerebral computed tomographic angiography showed a terminus of the right internal carotid artery. The occluded vessel was completely recanalized by endovascular therapy. Left-sided hemiparesis resolved completely. As a result of this study, cryptogenic stroke was considered in the etiology of stroke. In this report, we present a case of stroke with COVID-19, who developed large vessel occlusion accompanied by splenic infarction while hospitalized due to COVID-19 disease and was successfully treated with endovascular thrombectomy under epidemic conditions.

Highlights

The pathogenic mechanism underlying the cerebrovascular complications caused by COVID-19 is not clear, it is hypothesized that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) triggers the hyperinflammation process by binding to the angiotensin-converting enzyme-2 receptor on the surface of smooth muscle cells in the arterial endothelium
The results reported in the literature indicate that ischemic strokes with COVID-19 are associated with worse functional outcomes and higher mortality than non-COVID-19 ischemic strokes
We report a case of COVID-19, who presented with multiple thromboembolic complications involving the brain and the spleen, which was successfully treated by endovascular thrombectomy method under epidemic conditions

Summary

Introduction

Acute ischemic stroke (AIS) occurs at a rate of 1.3-5% in hospitalized coronavirus disease patients [2,3,5,6,7] This rate is even higher in intensive care patients [1]. A 71-year-old male patient with hypertension using regular antihypertensives was receiving inpatient treatment at our hospital's pandemic clinic for COVID-19 pneumonia. The right carotid artery was fully recanalized within 4.5 hours of the patient's clinical presentation [modified treatment in cerebral ischemia (mTICI) grade 3]. Two days after mechanical thrombectomy, the patient's state of consciousness completely recovered During his clinical follow-up, he complained of abdominal pain localized to the left upper quadrant, nausea, and vomiting.

Discussion

Conclusions

Disclosures