Posterior circulation stroke presenting as a new continuous cough: not always COVID-19

Abstract

A 19-year-old man was admitted with a 2-week history of continuous cough along with a day history of acute onset unsteadiness and hiccups. Given the current pandemic, he was initially suspected to have COVID-19, however he tested negative on two occasions. Subsequent brain magnetic resonance imaging (MRI)confirmed a small left acute and subacute lateral medullary infarction with chest X-ray suggesting aspiration pneumonia with right lower lobe collapse. This is a distinctive case of posterior circulation stroke presenting with a new continuous cough in this era of COVID-19 pandemic. We anticipate based on MRI findings that his persistent cough was likely due to silent aspiration from dysphagia because of the subacute medullary infarction. It is therefore imperative that healthcare workers evaluate people who present with new continuous cough thoroughly to exclude any other sinister pathology. We should also be familiar with the possible presentations of posterior circulation stroke in this pandemic era.

Keywords: infectious diseases; stroke.

Figure 1

(A) DWI b0 image of the lesion in the lateral part of the left medulla. (B) DWI b1000 image of the lesion in the lateral part of the left medulla. (C) ADC map demonstrating the variable diffusion restriction in the lesion suggestive of acute on a subacute infarct. (D) Coronal fluid attenuated inversion recovery (FLAIR) image showing an infarct in the left medulla.

Figure 2

(A) Chest radiograph done at the time of respiratory distress, showing consolidation and collapse in the right lower lung zones initially suspicious for COVID-19. (B) Chest radiograph after 3 days of antibiotics for the treatment of aspiration pneumonia, showing significant improvement in the chest radiograph.