#NEJMClinicalCase : Large-Vessel Stroke as a Presenting Feat
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Cough, headache, and chills lasting 1 week developed in a previously healthy 33-year-old woman (Patient 1). She then had progressive dysarthria with both numbness and weakness in the left arm and left leg over a period of 28 hours. She delayed seeking emergency care because of fear of Covid-19.

When she presented to the hospital, the score on the National Institutes of Health Stroke Scale (NIHSS) was 19 (scores range from 0 to 42, with higher numbers indicating greater stroke severity), and computed tomography (CT) and CT angiography showed a partial infarction of the right middle cerebral artery with a partially occlusive thrombus in the right carotid artery at the cervical bifurcation. Patchy ground-glass opacities in bilateral lung apices were seen on CT angiography, and testing to detect SARS-CoV-2 was positive. Antiplatelet therapy was initiated; it was subsequently switched to anticoagulation therapy. Stroke workup with echocardiography and magnetic resonance imaging of the head and neck did not reveal the source of the thrombus. Repeat CT angiography on hospital day 10 showed complete resolution of the thrombus, and the patient was discharged to a rehabilitation facility.

Over a 2-week period from March 23 to April 7, 2020, a total of five patients who were younger than 50 years of age presented with new-onset symptoms of large-vessel ischemic stroke. All five patients tested positive for Covid-19. By comparison, every 2 weeks over the previous 12 months, this hospital has treated, on average, 0.73 patients younger than 50 years of age with large-vessel stroke.

While a relationship between COVID-19 and an increased risk of ischemic stroke seems plausible, a higher level of evidence will be needed to substantiate these findings and to demonstrate causality.

Source: https://www.nejm.org/doi/full/10.1056/NEJMc2009787
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Dr. D●●●●●●●●v B●●●t
Dr. D●●●●●●●●v B●●●t Internal Medicine
Very nice..
May 5, 2020Like1