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Published on: August 11, 2023
Multiple simultaneous embolic cerebral infarctions 11 months after COVID-19
Rajiv Advani1,2, Torbjørn Austveg Strømsnes3,4, Espen Stjernstrøm5
1Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.
Insights
A persistent coagulopathy following COVID-19 can lead to venous thromboembolism (VTE) and paradoxical cerebral emboli, even months after the initial infection. This case highlights a serious long-term complication of 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.
Background:
The coronavirus disease (COVID-19) pandemic has led to an unprecedented worldwide burden of disease. However, little is known of the longer-term implications and consequences of COVID-19. One of these may be a COVID-19 associated coagulopathy that can present as a venous thromboembolism (VTE) and further, as multiple paradoxical cerebral emboli.
Case Presentation:
A 51 year old man presented to the emergency department with multiple simultaneous embolic cerebral infarctions 11 months after mild COVID-19. In the subacute phase of the COVID-19 illness the patient developed increasing shortness of breath and was found to have an elevated D-dimer and multiple bilateral segmental pulmonary emboli. He was subsequently treated with 3 months of anticoagulation for a provoked VTE. The patient then presented 11 months after the initial COVID-19 diagnosis with multiple simultaneous cerebral infarctions where no traditional underlying stroke etiology was determined. A patent foramen ovale (PFO) and an elevated D-dimer were found suggesting a paradoxical thromboembolic event due to an underlying coagulopathy.
Conclusions:
This case report highlights the one of the potentially more serious complications of long-term COVID-19 where VTE due to a persistent coagulopathy is seen almost a year after the initial illness. Due to the highly prevalent nature of PFO in the general population, VTE due to COVID-19 associated coagulopathy could lead to ischemic stroke. This case report highlights the possibility for an underlying COVID-19 associated coagulopathy which may persist for many months and beyond the initial illness.
