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.

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