stroke; acute ischemic stroke; SARS-CoV-2; COVID-19; coronavirus infections/complications; thrombophilia; hypercoagulable state; pregnancy; pandemics


Clinical Epidemiology | Family Medicine | Hematology | Infectious Disease | Internal Medicine | International Public Health | Medical Immunology | Medical Microbiology | Microbiology | Neurology | Obstetrics and Gynecology | Other Medicine and Health Sciences | Reproductive and Urinary Physiology | Virology | Virus Diseases


Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left arm and left leg weakness with National Institute of Health Stroke Scale (NIHSS) of 10. Computed tomography of the brain showed an acutely evolving ischemic infarction in the right middle cerebral artery territory. Other etiologies for causes of her ischemic stroke were ruled out through supporting laboratory testing. Since she did not present early enough due to concerns about the Coronavirus pandemic, tissue plasminogen activator was not administered. COVID-19 was suspected, confirmed and deemed the likely explanation of the cause of her acute ischemic large-vessel stroke. The patient was treated with aspirin and clopidogrel daily and showed significant improvement of her left-sided weakness. She eventually regained her ability to walk and was still pregnant at the time of follow-up.

Conclusions: COVID-19 can be difficult to diagnose since the presentation can vary widely and initial presentation may range from asymptomatic carrier states such as in our patient. In this case, we explain how we reached a diagnosis of AIS likely secondary to COVID-19 and provide further discussion regarding the neurological manifestations and treatment in pregnancy.