Elsevier

Clinical Imaging

Volume 69, January 2021, Pages 285-288
Clinical Imaging

Neuroradiology
Multiple embolic stroke on magnetic resonance imaging of the brain in a COVID-19 case with persistent encephalopathy

https://doi.org/10.1016/j.clinimag.2020.09.010Get rights and content

Highlights

  • Hypercoagulopathy and vascular endothelial dysfunction have been proposed as complications of COVID 19 which can lead to stroke.

  • Diagnoses of stroke in critically ill patients hospitalized with COVID-19 using MRI brain can be challenging due to multiple factors.

  • Patient with COVID-19 with stroke in multiple vascular territories after he had persistent encephalopathy and dysarthria.

  • MRI brain is more sensitive and specific modality to detect brain tissue that has been damaged by an ischemic stroke than a CT head.

Abstract

The pulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (COVID-19) are well known. The literature on neurological manifestations and complications in patients with COVID-19 has been increasing but is still sparse. At present, there are only a few reported case reports and clinical studies on neurological manifestations of COVID-19, of which ischemic stroke is one of the most common ones. Coagulopathy and vascular endothelial dysfunction have been proposed as the complications of COVID-19 which can ultimately lead to ischemic stroke. In this case report, we present a case of multifocal ischemic stroke in a patient with COVID-19. This patient had persistent encephalopathy and dysarthria after recovering from hypoxic respiratory failure and subsequently developed ischemic stroke in multiple vascular territories during hospital admission.

Abbreviations

COVID-19
coronavirus disease 2019
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
ATS/IDSA
American Thoracic Society and Infectious Disease Society of America
CT
computed tomography
RT PCR
reverse transcription polymerase chain reaction
L
liters
μl
microliters
MRI
magnetic resonance imaging
ng
nanogram
BUN
blood urea nitrogen
CRP
C-reactive protein
aPTT
activated partial thromboplastin time
DWI
diffusion weighted image
ADC
apparent diffusion coefficient
FLAIR
fluid attenuated inversion recovery
SWI
susceptible weighted imaging

Keywords

Coronavirus disease 2019
COVID-19
Embolic stroke
Severe acute respiratory syndrome coronavirus 2
SARS-CoV-2
Stroke
MRI brain

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