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Título

Case Report: Acute Cerebrovascular Event With COVID-19 Infection, a rare and serious complication

RESUMO

CASE PRESENTATION
A 60-year-old male patient, diabetic, hypertensive and previously vaccinated with one dose of COVID-19 vaccine ( ChAdOx1), was isolated at home for COVID-19, with a positive antigen test and first symptoms 13 days before admission. He was admitted presenting aphasia and right hemiplegia, with no respiratory distress. His cranial computed tomography (CT) had an extensive commitment at the territory of irrigation of the middle cerebral artery (MCA). Another finding was internal carotid and MCA occlusion in CT angiography.

Chest CT showed a 40% parenquimal commitment with ground-glass opacification, and bronchopneumonia. He was treated with antibiotics, corticotherapy. During hospitalization he presented with delirium and acute respiratory distress, afterward, thromboembolism was diagnosed by CT angiography. Then, mechanical ventilation was needed for 6 days. The patient had a 2 months stay in hospital, due to urinary tract infection, persistent fever and pseudomembranous colitis. Finally, he was discharged with no oxygen supplementation and was prescribed anticoagulation. Moreover, he maintained his motor impairment and improved his aphasia.

DISCUSSION
COVID-19 is known as a proinflammatory state associated with thrombophilia. There is an increased risk of thrombotic events, even though stroke is considered rare. The incidence of ischemic stroke associated with COVID-19 patients has ranged from 0.4 to 2.7 percent.

A study showed that COVID-19 patients were more likely to have a cryptogenic stroke. Outcomes were worse, including longer length of stay, intensive care unit care (ICU) stay , greater rate of neurological worsening, and in-hospital death. In comparison, our patient had a long length stay, with ICU care needed. Nevertheless, our patient had a atherothrombotic event and evolved with a neurological improvement.

Similar to our case, another article demonstrated the association between ischemic stroke and pulmonary embolism. Besides,the median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks.

FINAL COMMENTS
Stroke appears to be a rare but serious event associated with COVID-19 patients. Considering the poor outcome described in literature, our patients, despite all complications, had improvement of his conditions. However, the characteristics of COVID-19 patients with stroke vary in the current literature, therefore more description is needed.

Palavras Chave

Covid-19, Stroke