Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020

Abstract

We describe 2 cases in coronavirus disease patients in France involving presumed thrombotic stroke that occurred during ongoing anticoagulation treatment for atrial fibrillation stroke prophylaxis; 1 patient had positive antiphospholipid antibodies. These cases highlight the severe and unique consequences of coronavirus disease-associated stroke.

Keywords: 2019 novel coronavirus disease; COVID-19; Coronavirus diseases; France; SARS-CoV-2; central nervous system; infarction; pneumonia; respiratory diseases; severe acute respiratory syndrome coronavirus 2; stroke; viruses; zoonoses.

Figure

Cerebral magnetic resonance image (MRI) showing acute ischemic stroke in multiple vascular areas of 2 coronavirus disease patients, France. A–F) Patient 1. Diffusion weighted imaging (DWI) showed hyperintensive lesions of bilateral cerebellar hemispheres (arrows, A), right occipital cortex (arrows, B), bilateral centrum semiovale and bilateral parietal cortex (arrows, C). A part of the lesions are already hyperintensive in FLAIR (fluid-attenuated inversion recovery) sequences (arrows, D, F). Normal FLAIR sequence of the right occipital cortex; early stroke MRI (E). MRI quality is reduced because of dental artifact. G–L) Patient 2. Cerebral MRI showed multiple small ischemic infarctions with hyperintensive lesions (arrows) in bilateral cerebellar hemispheres (DWI [G], FLAIR [J; only left hemisphere]), bilateral occipital cortex (DWI [H], FLAIR [K]), main infarction in the left frontal lobe and small biparietal infarctions (DWI [I], FLAIR [L]).