A Case of COVID-19 With Memory Impairment and Delayed Presentation as Stroke

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory pathogen with remarkable properties of multisystem involvement and numerous complications. The coronavirus disease of 2019 (COVID-19) presenting as stroke is becoming more common. Herein, we describe an unusual case of COVID-19 in a patient who initially presented with myalgia, fatigue, loss of taste and smell, and non-specific memory impairment. Two months after infection with SARS-CoV-2, the patient presented with acute onset of right-sided weakness, sensory loss, and worsening cognitive impairment. Reverse transcription-polymerase chain reaction was performed to detect the SARS-CoV-2 virus, and the results were positive at the time of initial infection as well as during the current admission. Neuroimaging suggested a subacute ischemic infarct in the middle cerebral artery. The patient was re-tested for SARS-CoV-2 and found to be positive, but the cycle threshold was high (40.4) along with a positive test for immunoglobulin-G (IgG) for SARS-CoV-2. This report highlights a unique case of stroke-related to COVID-19 infection in a middle-aged woman with otherwise mild symptomatic illness. The patient had a chronic ischemic stroke with delayed presentation two months after the initial symptomatic viral infection. This case underscores the importance of neurological assessment as well as timely evaluation of patients presenting with COVID-19 and any neurological concerns to recognize stroke as a complication of COVID-19 promptly.

Keywords: covid-19; cycle threshold; ischemic cva; memory issues; sars-cov-2 (severe acute respiratory syndrome coronavirus -2); stroke; stroke recrudescence.

Figure 1. Noncontrast CT of the patient’s head showing hypo-density in the left frontal lobe (red arrows).

Abbreviation: CT, computed tomography

Figure 2. MRI of the brain showing (A) a hypo-intense signal in the left frontal lobe on diffusion-weighted imaging sequence, (B) a hyper-intense signal in the left frontal lobe on T2 flair sequence, (C) a hypo-intense signal on apparent diffusion coefficient sequence, and (D) a mild narrowing left MCA on CT angiography.

Abbreviations: MRI, magnetic resonance imaging; MCA, middle cerebral artery; CT, computed tomography

Figure 3. Chest X-ray showing no significant abnormalities and reported as normal