Ischemic stroke associated with novel coronavirus 2019: a report of three cases

Abstract

Introduction: There is limited evidence about the neurological manifestations of COVID-19 in infected patients. In this report, we describe three patients with ischemic stroke associated with COVID-19 infection.

Methods: We report 3 cases of adult patients with ischemic stroke and novel coronavirus 2019 infection. Case 1 is an 88-year-old female with acute left hemiplegia and right peripheral facial paresis that she had a fever along with stroke symptoms. Case 2 is an 85-year-old female with left hemiplegia and drowsiness who had a weakness, asthenia, and dry cough 3 days before appearing stroke signs. Case 3 is a 55-year-old male with acute Broca's aphasia and right hemiplegia who experience fever and respiratory problems 3 days after admission.

Results: The clinical symptoms of infected patients with COVID-19 have been associated with severe symptoms of ischemic stroke. Two patients were admitted to the ICU. RT-PCR of the oropharyngeal sample was positive in three cases. All patients had the involvement of large cerebral arteries.

Conclusion: The mechanism by which COVID-19 causes ischemic stroke is unknown but it is likely by production inflammatory cytokines or direct infection of cerebral arteries. Therefore, regarding the current situation of the COVID-19 pandemic, it is indispensable that the possible diagnosis of COVID-19 vasculopathy is considered in all ischemic strokes of unclear etiology.

Keywords: COVID-19; Ischemic stroke; case report; novel coronavirus.

Figure 1.

Brain and Lung CT scan of three patients. Imaging of Patient 1 shows low-density at right cerebellar (A); grand glass opacity at bilateral lung (B); Patient 2 shows attenuation at right hemisphere (C); grand grass opacity at the right lower lobe and bilateral pleural effusion (D); patient 3 shows low-density at left basal ganglion (E); pleural effusion and peripheral grand glass opacity bilaterally (F).