Simultaneous Arterial and Venous Brain Infarctions in a Patient with COVID-19: Case Report

Abstract

Stroke is one of the manifestations of COVID-19-associated coagulopathy. Arterial infarcts are the most common presentation; however involvement of both arterial and venous irrigation is possible but rare. We report, what is, to our knowledge, the second case of concomitant arterial and venous brain thrombosis evidenced in magnetic resonance. A 62-year-old man presented with acute weakness of the left hand and lack of coordination in the left arm. Nine days earlier, he was positive for SARS-CoV-2 RT-PCR. The brain images revealed two subacute infarcts, one corresponding to the territory of the right middle cerebral artery, and the other in the right frontal cortical vein. The existence of both venous and arterial brain infarcts due to COVID-19 infection, has been previously reported once. Most of the cases of stroke are due to only arterial thrombosis; therefore, this could be the starting point to start collecting data about simultaneous compromise in order to assess and compare outcomes, severity of the disease, among other variables.

Rare case of simultaneous cerebral artery and venous sinus thrombosis in the setting of elevated factor VIII and combined oral contraceptive pills

“…Simultaneous CVST and ischemic arterial infarcts have been reported before in the setting of profound iron deficiency anemia, thrombocytosis, hyperhomocysteinemia, and in patients with SARS‐CoV‐2 (COVID‐19) infection 3,4,6 . Bo‐Lin Ho et al 5 .…”

“…Simultaneous CVST and ischemic arterial infarcts have been reported before in the setting of profound iron deficiency anemia, thrombocytosis, hyperhomocysteinemia, and in patients with SARS‐CoV‐2 (COVID‐19) infection. 3 , 4 , 6 Bo‐Lin Ho et al 5 . reported a case of simultaneous CSVT and ischemic stroke in 41 years old with acquired protein C and protein S deficiency, iron deficiency anemia (IDA), and cryoglobulinemia, which were within normal in our patient.…”

“…Simultaneous cerebral arterial and venous infarction has been reported in very few case reports with homocysteinemia and acquired thrombophilia. [3][4][5][6] To the best of our knowledge, this is the first case of concurrent CVST and PICA ischemic stroke in a young female patient on COCP found to have elevated factor VIII.…”

“…2 CVST common risk factors encompass inherited and acquired prothrombotic conditions like hormonal therapy, malignancy, infection, and trauma-related injuries.Simultaneous cerebral arterial and venous infarction has been reported in very few case reports with homocysteinemia and acquired thrombophilia. [3][4][5][6] To the best of our knowledge, this is the first case of concurrent CVST and PICA ischemic stroke in a young female patient on COCP found to have elevated factor VIII.…”

Alexia without agraphia in an elderly man due to stroke secondary to COVID-19 infection

“…Both arterial and venous strokes have been reported independently, presenting either as large artery occlusions or as cerebral venous sinus thrombosis [ 6 , 7 ]. There have only been two previous reports of simultaneous arterial and venous stroke [ 8 , 9 ]. The sigmoid sinus, transverse sinus, and jugular vein along with middle cerebral artery were all involved in these patients.…”