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Case Reports
. 2020 Nov 24;2020(11):omaa096.
doi: 10.1093/omcr/omaa096. eCollection 2020 Nov.

Large-vessel thrombotic stroke despite concurrent therapeutic anticoagulation in COVID-19-positive patient

Andrew Shoukry  1 , Thomas A Kite  1
Affiliations
Case Reports

Large-vessel thrombotic stroke despite concurrent therapeutic anticoagulation in COVID-19-positive patient

Andrew Shoukry et al. Oxf Med Case Reports. .

Abstract

The current COVID-19 pandemic caused by the novel SARS-CoV-2 virus is now recognized to be associated with a coagulopathy that can result in arterial and venous thromboses. In this report, we describe a case of large-vessel cerebrovascular thrombus in a therapeutically anticoagulated 89-year-old male admitted with COVID-19 infection. Despite clinical improvement following COVID-19 pneumonitis, symptoms of an acute left-sided total anterior circulation stroke rapidly developed 10 days after initial COVID-19 symptom onset. Computed tomography angiography imaging confirmed acute large-vessel thrombus in the terminal segment of the internal carotid artery resulting in acute right middle cerebral artery territory infarction. Thromboembolic events in the context of COVID-19 infection have recently been described in critically unwell patients. However, to the best of our knowledge, this is one of the first cases of large-vessel thrombus in a patient with COVID-19 infection receiving concurrent therapeutic anticoagulation.

Keywords: neuroimaging; neurology; stroke.

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Figures

Figure 1
Figure 1
Chest radiography demonstrating bi-basal and peripheral left mid zone pulmonary infiltrates and previous left-sided dual chamber permanent pacemaker (with capped and buried right ventricular lead).
Figure 2
Figure 2
Computed tomography of the brain showing low attenuation in the right basal ganglia and high density in the right M1 segment of the middle cerebral artery.
Figure 3
Figure 3
Computed tomography angiography demonstrating thrombus occluding the right middle cerebral artery.
See this image and copyright information in PMC

References

    1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13. - PMC - PubMed
    1. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18:844–7. - PMC - PubMed
    1. Spyropoulos AC, Levy JH, Ageno W, Connors JM, Hunt BJ, Iba T et al. Scientific and standardization committee communication: clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020;18:1859–65. - PMC - PubMed
    1. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 2020;382:e60. - PMC - PubMed
    1. Beyrouti R, Adams ME, Benjamin L, Cohen H, Farmer SF, Goh YY et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2020;91:889–91. - PMC - PubMed

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