Large Middle Cerebral Artery Ischemic Stroke in a Therapeutically Anticoagulated Patient With Severe SARS-CoV-2 Infection.

Authors

Humdoon L. Choudhry, HCA HealthcareFollow
Jessica Klingensmith, HCA HealthcareFollow
Lloyd D. Border, HCA HealthcareFollow
My Myers, HCA HealthcareFollow
Edgar Mercado, HCA HealthcareFollow

Division

West Florida

Hospital

St. Petersburg General Hospital

Document Type

Case Report

Publication Date

11-30-2021

Keywords

COVID-19, SARS-CoV-2, ischemic stroke, coagulopathy, inflammatory thrombosis

Disciplines

Cardiovascular Diseases | Family Medicine | Virus Diseases

Abstract

INTRODUCTION: Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with hypercoagulability which can predispose infected patients to both arterial and venous thromboembolic complications. Despite therapeutic anticoagulation, there remains a risk of ischemic strokes, which may lead to adverse patient outcomes. Only a few cases are described in the literature regarding SARS-CoV-2 positive patients developing thrombotic ischemic strokes despite therapeutic anticoagulation.

CASE REPORT: The following is a case discussion regarding a 71-year-old female with past medical history of hypertension, diabetes mellitus type 2, hyperlipidemia, and hypothyroidism who was admitted with severe SARS-CoV-2 infection to the intensive care unit and later developed acute left upper extremity weakness on the 5th day of her admission. Initial National Institutes of Health stroke scale (NIHSS) was 15. Subsequent brain imaging was significant for right middle cerebral artery ischemic stroke. The patient was therapeutically anticoagulated with 1.5 mg/kg subcutaneous dose of Enoxaparin since day 1 of her admission. D-dimer upon admission was 1.84 mg/L (

CONCLUSION: Because of the severity of inflammation and coagulopathic sequelae of coronavirus disease 2019, anticoagulation failure may occur and lead to adverse patient outcomes. Our case report is one of the few discussions in the current literature regarding large vessel thromboembolic ischemic strokes despite therapeutic anticoagulation.

Comments

Published online ahead of print.

Publisher or Conference

Neurologist

Recommended Citation

Choudhry H, Klingensmith J, Border Dalton L, Myers M, Mercado E. Large Middle Cerebral Artery Ischemic Stroke in a Therapeutically Anticoagulated Patient With Severe SARS-CoV-2 Infection. Neurologist. 2021;10.1097/NRL.0000000000000389. doi:10.1097/NRL.0000000000000389