Multiple simultaneous embolic cerebral infarctions 11 months after COVID-19

Area of Science:

• Neurology
• Hematology
• Infectious Diseases

Background:

• The COVID-19 pandemic presents long-term health challenges.
• COVID-19 associated coagulopathy is a potential complication.
• Venous thromboembolism (VTE) and paradoxical cerebral emboli are serious manifestations.

Purpose of the Study:

• To report a case of paradoxical cerebral emboli secondary to COVID-19 associated coagulopathy.
• To highlight the persistent nature of coagulopathy post-COVID-19.
• To underscore the risk of ischemic stroke in patients with patent foramen ovale.

Main Methods:

• Case report of a 51-year-old male patient.
• Presentation with multiple simultaneous embolic cerebral infarctions 11 months post-mild COVID-19.
• Diagnostic workup included D-dimer levels, imaging, and patent foramen ovale (PFO) assessment.

Main Results:

• Patient experienced pulmonary emboli in the subacute phase of COVID-19, treated with anticoagulation.
• Presented 11 months later with cerebral infarctions of unknown etiology.
• Diagnosis of paradoxical thromboembolic event suggested by PFO and elevated D-dimer.

Conclusions:

• COVID-19 associated coagulopathy can persist for months, leading to VTE.
• The presence of a PFO increases the risk of ischemic stroke from COVID-19 related coagulopathy.
• This case emphasizes the need to consider long-term thrombotic risks after COVID-19.