Large Vessel Occlusion Causing Cerebral Ischemic Stroke in Previously Healthy Middle-Aged Recently Recovered from Severe COVID-19 Infection

Abstract

Background Severe acute respiratory syndrome coronavirus (SARS-CoV-2) due to novel coronavirus disease 2019 (COVID-19) has led to an unprecedented worldwide pandemic with diverse respiratory symptoms as well as systemic manifestations and complications. The neurological manifestations of COVID-19 include, but are not limited to, headache, cerebrovascular disease, and skeletal muscle injury. Case Report Herein, we present a case of stroke with large vessel occlusion in a middle-aged man, who recently recovered from severe SARS-CoV-2 infection. This patient is not known to have any medical illness or surgical history and has no cerebrovascular risk factors. Moreover, the patient underwent extensive investigations, including neuroimaging, cardiac and laboratory work-up with no evidence of stroke etiology. Conclusion The mechanism of cerebrovascular events in the setting of COVID-19 is still uncertain and probably multi-factorial. The prevailing hypothesis is a strong thrombotic tendency, which may even be prolonged after complete recovery. In our patient’s case, hypercoagulability in the context of viral infection is the most likely mechanism for the stroke. Further studies are needed to find out the exact pathogenesis of thromboembolic events in the setting of COVID-19 infection as well as the efficacy, safety, dosage, and duration of anticoagulants in such conditions.

Acidente vascular encefálico isquêmico decorrente da Hipercoagulabilidade ocasionada pela Covid-19: uma revisão integrativa

“…O SARS-CoV-2, é conhecido usualmente por causar sintomas respiratórios, podendo evoluir para a SDRA até à falência de múltiplos órgãos, bem como, acometer o sistema nervoso central 30 . Existem diversos relatos na literatura que sugerem uma associação entre a infecção pela COVID-19 e a ocorrência de complicações tromboembólicas 16 , cursando com a ativação sistêmica da cascata de coagulação e tendo os três componentes da tríade de Virchow (estase sanguínea, hipercoagulabilidade e lesão endotelial) como a base da trombose, especialmente naqueles com a forma grave da doença 31 Apesar de os pacientes mais suscetíveis a sofrerem AVEi secundário à infecção pelo SARS-CoV-2 apresentarem comorbidades, o relato de caso de Alashim et al 16 Quanto à incidência de AVEi em pacientes infectados pelo SARS-CoV-2, no estudo de Stamm et al 9 foi de 1-2%. Já na revisão sistemática de Tan et al 29 , o valor encontrado foi de 1,2%.…”

Large-Vessel Occlusion Stroke Associated with Covid-19: A Systematic Review and Meta-Analysis of Outcomes

“…The study by Misra et al 5) , which included 350 studies, providing data from 145,721 patients with COVID-19, found that one in 50 patients experienced a stroke. In particular, the increase in cases of large vessel occlusion (LVO) in patients with COVID-19 6) is noteworthy due to the increased risk of mortality and worst sixth-month good outcome (modified Rankin Scale score ≤ 2) that they present 7) .We conducted a systematic review and meta-analysis to assess the influence of COVID 19 on clinical outcomes and treatment success in patients with stroke due to occlusion of large vessels.…”