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Case Reports
. 2020 Sep 30;51(3):e504560.
doi: 10.25100/cm.v51i3.4560.

Internal carotid artery thrombosis in COVID 19

Yadira Álvarez Moreno  1 , Janeth Bú Figueroa  1 , Efraín Bú Figueroa  2 , Marco Soto Fonseca  3 , Javier Escober Torres  3
Affiliations
Case Reports

Internal carotid artery thrombosis in COVID 19

Yadira Álvarez Moreno et al. Colomb Med (Cali). .

Abstract
in English, Spanish

Case description: 37-year-old female with PCR-RT swab for COVID-19 positive, with neurological manifestation as a result of internal carotid artery occlusion.

Clinical findings: Nasal congestion and sneezing of 5 days duration; pulsatile headache in the left hemicranium 3 days prior to admission, with intensity 6/10 according to the visual analogue scale, accompanied by phosphenes, photophobia and diplopia; with subsequent developing right hemiparesis over a 26-hour period.

Treatment and result: She was given medical management with oral antiplatelet agents and anticoagulants (subcutaneous and oral) during his hospitalization, it was not possible to perform thrombolysis and thrombectomy due to the high risk of complications. He was discharged at 14 days, without functional limitation, symmetrical strength in upper and lower limbs, bilateral visual acuity 20/20, denying headache.

Clinical relevance: The case presented here describes a pattern in how data supporting an association between COVID-19 and stroke in young populations with or without typical vascular risk factors, sometimes with only mild respiratory symptoms, is increasing. Prospective studies are required to further evaluate this association, as well as anticoagulation studies to prevent these potentially life-threatening events.

Descripción del caso: Mujer de 37 años con hisopado PCR-RT para COVID-19 positivo, con manifestación neurológica por oclusión de la arteria carótida interna.

Hallazgos clínicos: Congestión nasal y estornudos de 5 días de duración; cefalea pulsátil en hemicráneo izquierdo 3 días antes del ingreso, con intensidad 6/10 según la escala visual analógica, acompañada de fosfenos, fotofobia y diplopía; con posterior desarrollo de hemiparesia derecha durante un período de 26 horas.

Tratamiento y resultado: Se le brindó manejo médico con antiagregantes plaquetarios orales y anticoagulantes (subcutáneos y orales) durante su internación, no fue posible realizar trombólisis y trombectomía por alto riesgo de complicaciones. Fue dado de alta a los 14 días, sin limitación funcional, fuerza simétrica en miembros superiores e inferiores, agudeza visual bilateral 20/20, negando cefalea.

Relevancia clínica: Se describe un patrón que indica cómo están aumentando los datos que apoyan una asociación entre COVID-19 y el accidente cerebrovascular en poblaciones jóvenes con o sin factores de riesgo vascular típicos, a veces con solo síntomas respiratorios leves. Se requieren estudios prospectivos para evaluar más a fondo esta asociación, así como estudios de anticoagulación para prevenir estos eventos potencialmente mortales.

Keywords: COVID-19; SARS-CoV-2; carotid artery; carotid thrombosis; endothelial injury; hypercoagulability; occlusion.

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Conflict of interest statement

Conflict of interest: The authors declare that they have no conflicts of interest in the publication of this article.

Figures

Figure 1
Figure 1. Carotid Doppler Ultrasound. No evidence of flow when applying color or spectral Doppler due to the presence of echogenic material inside. (Green box)
Figure 2
Figure 2. A. Axial FLAIR Magnetic Resonance Imaging (MRI), small left lateral frontal cortical hyperintense area. B, C. Diffusion MRI, confirms acute ischemic cerebrovascular event, left frontal and small lacunar ischemic events in the left parietal lobe. D. Control Axial MRI, shows a hyperintense lesion in the left frontal region and a small sequel lesion in the left parietal lobe. E, F. Angio -Persistently 3D-TOF, no signal left middle left internal carotid artery and cerebral artery.
Figura 1
Figura 1. Ecografía Doppler carotídeo. No hay evidencia de flujo al aplicar Doppler color o espectral debido a la presencia de material ecogénico en su interior. (Recuadro verde)
Figura 2
Figura 2. A. Imagen de resonancia magnética (RM) FLAIR axial, pequeña área hiperintensa cortical frontal lateral izquierda. B, C. La resonancia magnética de difusión confirma evento cerebrovascular isquémico agudo, frontal izquierdo y eventos isquémicos lacunares pequeños en el lóbulo parietal izquierdo. D. Control Axial MRI, muestra una lesión hiperintensa en la región frontal izquierda y una pequeña secuela en el lóbulo parietal izquierdo. E, F. Angio -Persistentemente 3D-TOF, sin señal arteria carótida interna izquierda media izquierda y arteria cerebral.
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X. China novel coronavirus investigating and research team a novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. World Health Organization Coronavirus (COVID-2019) situation reports. 2020. [2020 20 August]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio...
    1. Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W. Coagulopathy and antiphospholipid antibodies in patients with COVID-19. N Engl J Med. 2020;382(17):e38. doi: 10.1056/NEJMc2007575. - DOI - PMC - PubMed
    1. Klok FA, Kruip MJHA, Van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145–147. doi: 10.1016/j.thromres.2020.04.013. - DOI - PMC - PubMed
    1. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP. Large-Vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med. 2020;382(20):e60. doi: 10.1056/NEJMc2009787. - DOI - PMC - PubMed

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