Stroke and COVID19: Not only a large-vessel disease

Abstract

Recent evidence has underlined the association between large-vessel stroke and COVID-19, probably due to a proinflammatory and prothrombotic microenvironment induced by SARS-CoV-2. Here, we report the case of a young fit woman affected by COVID-19 without any flu-like symptom, who suffered from speech disorder and left hemiparesis. Brain magnetic resonance evidenced two small acute brain infarctions in right perirolandic cortex without signs of previous ischemic lesions and hemorrhagic infarction. Diagnostic workup excluded cardiac embolic sources, acquired and inherited thrombophilia or autoimmune diseases. Two positive nasopharyngeal swab tests and high titers of serum specific IgA/IgM confirmed COVID-19 diagnosis. In our case stroke seems to be the only manifestation of SARS-COV-2 infection. Therefore the hypothesis of an underlying viral infection, as COVID-19, should be investigated in all the cases of small vessel cryptogenic stroke.

Keywords: COVID19; SARS-COV-2; Small-vessel occlusion; Stroke.

Fig. 1

An axial section of diffusion-weighted (Panel A), Apparent diffusion coefficient (ADC) (Panel B), Fluid attenuation inversion recovery (FLAIR) (Panel C) and Susceptibility-weighted Angiography (SWAN) (Panel D) images of the brain shows two small acute brain infarctions (arrows) in right perirolandic cortex without signs of previous ischemic lesions and hemorrhagic infarction.