Middle cerebral artery ischemic stroke and COVID-19: a case report
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CASE REPORT
Middle cerebral artery ischemic stroke and COVID-19: a case report Guido Bigliardi 1 & Ludovico Ciolli 1,2 & Giada Giovannini 1 & Laura Vandelli 1 & Maria Luisa Dell’Acqua 1 & Giuseppe Maria Borzì 1 & Livio Picchetto 1 & Francesca Rosafio 1 & Riccardo Ricceri 1 & Stefano Meletti 1,2 Received: 28 June 2020 / Revised: 10 August 2020 / Accepted: 18 August 2020 # Journal of NeuroVirology, Inc. 2020
Abstract We present a clinical case of a patient with SARS-CoV-2 infection and respiratory symptoms, complicated with a pro-thrombotic state involving multiple vascular territories and concomitant interleukin-6 increase. This case underlines the possibility to develop a COVID-19-related coagulopathy. Keywords SARS-CoV-2 . COVID . Coagulopathy . Stroke . IL-6
Introduction Systemic and neurological complications of SARS-CoV-2 infection are increasingly recognized. Several studies described the typical clinical presentation with fever, cough, and fatigue (Lovato and De Filippis 2020). Most recent publications (Klok et al. 2020) showed how COVID-19 might involve not only the respiratory system but also cause a prothrombotic state leading to peripheral veins thrombosis and pulmonary embolism. Here, we report a case of a patient with SARS-CoV-2 infection that developed severe coagulopathy affecting both pulmonary and cerebral vessels.
Clinical case A 62-year-old patient presented to our emergency room with fever and dyspnea. He was affected by diabetes mellitus, ankylosing spondylitis previously treated with Adalimumab and currently on Secukinumab, and complicated with pulmonary fibrosis.
* Guido Bigliardi [email protected] 1
Stroke Unit – Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
2
Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Modena, Italy
He was firstly admitted to infectious diseases ward. A nasopharyngeal swap for SARS-CoV-2 resulted positive. Blood exams showed normal white blood cells with low lymphocyte levels and platelet counts, increased levels of D-dimer and lactate dehydrogenase (LDH), and slightly increased Creactive protein (CRP). Interleukin-6 (IL-6) was also elevated (Table 1). Therapies with oxygen, hydroxychloroquine, and prophylactic low molecular weight heparin (LMWH) were started. In the following days, the patient respiratory symptoms worsened with increasing need for oxygen therapy. Three days after admission, a marked increase in D-dimer was noted. Ddimer remained elevated in the following days (Fig. 1). Seven days after the admission, he suddenly developed respiratory insufficiency not responding to high flow oxygen administration, requiring ICU admission and mechanical ventilation. Blood exams were repeated; D-dimer was still markedly elevated; in comparison with the exams at admission, increased IL-6 (Fig. 1), severe thrombocytopenia, and only mildly increased prothrombin time and partial thromboplastin time were noted. Of interest,
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