D-dimer level elevation can aid in detection of asymptomatic COVID-19 presenting with acute cerebral infarction

Abstract

Coronavirus disease 2019 (COVID-19) mainly manifests as a respiratory syndrome, besides causing other complications. Severe COVID-19 may also present with coagulopathy, leading to venous thrombosis and cerebral infarction. Stroke is one of the complications associated with severe COVID-19. Generally, acute stroke is the second complication in patients with respiratory syndrome. Here, we present a case of COVID-19 in an 84-year-old female patient who did not manifest any respiratory symptoms; however, she presented with acute stroke. The patient had no cough or fever before the stroke onset, but the COVID-19 PCR was positive. The patient also had markedly elevated D-dimer levels. Our findings suggest that coagulopathy can occur, even in a patient with asymptomatic COVID-19 infection. To our knowledge, this is the first case of asymptomatic COVID-19 in a patient presenting with cerebral infarction. We concluded that elevation of D-dimer levels is one of the tools to ascertain COVID-19 infection in such patients.