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Ischaemic stroke as the presenting feature of COVID-19: a series of three cases from Qatar
Yousaf Iqbal1, Peter M Haddad1, Javed Latoo1
1Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar.
Insights
Coronavirus disease (COVID-19) can present as stroke, even without respiratory symptoms. This highlights the need to consider COVID-19 in stroke patients and vice versa.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Medicine
Background:
- Coronavirus disease 2019 (COVID-19) is primarily known for causing respiratory illness.
- Stroke is a recognized but less common complication of COVID-19, often occurring with respiratory symptoms.
Observation:
- Three patients presented with ischemic stroke as the primary manifestation of COVID-19.
- Two of these patients experienced no respiratory symptoms during their illness.
- The affected individuals were relatively young (40-50 years) with varying stroke risk factors.
Findings:
- COVID-19 infection was confirmed via RT-PCR, and stroke was diagnosed using brain imaging.
- Two patients exhibited large vessel occlusion and elevated D-dimer levels, indicative of hypercoagulability.
- Multiple infarcts were observed in two patients, suggesting widespread cerebrovascular impact.
Implications:
- Clinicians should consider COVID-19 in the differential diagnosis of stroke, particularly in younger patients or those with atypical presentations.
- Investigating for stroke is crucial in patients diagnosed with COVID-19, even those with mild or absent respiratory symptoms.
- This underscores the potential for severe neurological complications of COVID-19 beyond the respiratory system.
Abstract:
Most cases of stroke associated with coronavirus disease 2019 (COVID-19) occur during the course of a characteristic COVID-19 respiratory illness. We report three patients where the presenting feature of COVID-19 was stroke. Two patients had no respiratory symptoms throughout their clinical course. In each case, COVID-19 was confirmed by a reverse transcription polymerase chain reaction (RT-PCR) test and the diagnosis of ischaemic stroke by brain imaging. The patients were relatively young (40, 45 and 50 years). None had a prior history of cerebrovascular events. Stroke risk factors were absent in one, limited to overweight and smoking in another but more prominent in the third patient. Two patients had large vessel occlusion and elevated D-dimer levels. Multiple infarcts were seen in two patients. Clinicians should consider the possibility of COVID-19 in patients presenting with stroke and conversely consider investigating for stroke if a patient with COVID-19, even if mildly ill, develops acute neurological symptoms.
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