Abstract
BackgroundEmerging reports are describing stroke in young, otherwise healthy patients with coronavirus disease 2019, consistent with the theory that some of the most serious complications of coronavirus disease 2019 are due to a systemic coagulopathy. However, the relevance of both the severity of coronavirus disease 2019 illness and established vascular risk factors in these younger patients is unknown, as reports are inconsistent.Case presentationHere we describe a 39-year-old white male, who died after presenting simultaneously with a malignant large-vessel cerebrovascular infarct and a critical coronavirus disease 2019 respiratory illness. Doppler ultrasound revealed evidence of carotid plaque thrombosis. Blood tests revealed evidence of undiagnosed diabetes mellitus; however, the patient was otherwise healthy, fit, and active.ConclusionsThis unique case highlights a possible interaction between established risk factors and large-vessel thrombosis in young patients with coronavirus disease 2019, and informs future research into the benefits of anticoagulation in these patients.
Highlights
This unique case highlights a possible interaction between established risk factors and large-vessel thrombosis in young patients with coronavirus disease 2019, and informs future research into the benefits of anticoagulation in these patients
Current theories postulate that the most serious complications of coronavirus disease 2019 (COVID-19), including multiple reports of cerebrovascular disease [1], may be secondary to a systemic coagulopathy increasing the risk of thrombosis and the formation of microemboli [2]
This is thought to be a direct consequence of binding of the virus to angiotensin converting enzyme-2 (ACE2) receptors on the endothelial vessel lining [3], or the development of an antiphospholipid antibody [4]
Summary
Current theories postulate that the most serious complications of coronavirus disease 2019 (COVID-19), including multiple reports of cerebrovascular disease [1], may be secondary to a systemic coagulopathy increasing the risk of thrombosis and the formation of microemboli [2]. The patient had been self-isolating at home for approximately 2 weeks owing to symptoms of cough, fever, shortness of breath, and vomiting He presented to the emergency department 2 hours and 24 minutes following the onset of symptoms. Deterioration On the third day following admission, the patient underwent further combined neurological and respiratory deterioration He required 15 L/minute oxygen to maintain target saturation and became febrile with temperature of 39 °C. Repeat CT scan was performed (Fig. 3) and revealed evidence of a dense left middle cerebral artery (MCA) ischemic infarct with mass effect and 1 cm midline shift to the right, resulting in hydrocephalus and raised intracranial pressure. A crucial quantitative measurement of risk that can inform decisions regarding anticoagulation, which in such young patients with low bleeding risk is likely to be optimal management
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