The impact of COVID-19 on ischemic stroke

• Published in: Diagnostic pathology 2020-06, Vol.15 (1), p.78-78, Article 78
• Main Authors: Zhai, Pan, Ding, Yanbing, Li, Yiming
• Format: Article
• Language: English
• Subjects: Aged; Air temperature; Anti-inflammatory agents; Antiviral agents; Atorvastatin; Betacoronavirus - isolation & purification; Blood pressure; Body temperature; Brain Ischemia - diagnosis; Brain Ischemia - virology; Case Report; Case reports; Clinical Laboratory Techniques; Clopidogrel; Coronavirus Infections - complications; Coronavirus Infections - diagnosis; Coronaviruses; Cough; COVID-19; COVID-19 Testing; COVID-19 Vaccines; Cytokines; Disease transmission; Drug dosages; Drugs; Epidemics; Health aspects; Herbal medicine; Human communication; Humans; Hypertension; Hypoxemia; Hypoxia; Infection; Infections; Infectious diseases; Inflammation; Ischemia; Ischemic stroke; Laboratories; Leukocytes (eosinophilic); Lymphopenia; Male; Mortality; Muscle strength; Nucleic acids; Oral administration; Outbreaks; Oxygen content; Pandemics; Patients; Physicians; Pneumonia; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Polymerase chain reaction; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Stroke; Stroke - diagnosis; Stroke - virology; Traditional Chinese medicine; Viral diseases
• ISSN: 1746-1596; 1746-1596
• DOI: 10.1186/s13000-020-00994-0

The outbreak of a novel coronavirus since December 2019, became an emergency of major international concern. As of June 21, 2020, the SARS-CoV-2 pandemic has caused 8,769,844 confirmed infections with 463,745 fatal cases worldwide. The SARS-CoV-2 outbreak is a major challenge for clinicians. In our clinic, we found a rare case that a COVID-19 patient combined with ischemic stroke. A 79-year-old man was admitted to the Hubei Provincial Hospital of Traditional Chinese Medicine due to right limb weakness for 1 day and slight cough for 1 week. At presentation, his oxygen saturation was 94.2% on room air and body temperature was 37.3 °C (99.0 °F) with some moist rales. Neurological examination showed right limb weakness, and the limb muscle strength was grade 4. The left leg and arms were unaffected. In addition, runs of speech were not fluent enough with tongue deviation. Laboratory studies showed lymphopenia and eosinophilic granulocytopenia. Chest CT revealed bilateral pulmonary parenchymal ground-glass and consolidative pulmonary opacities, with a peripheral lung distribution. Real-time polymerase chain reaction (RT-PCR) from throat swab sample was positive for SARS-CoV-2 nucleic acid. This patient was treated with antiviral drugs and anti-inflammatory drugs with supportive care until his discharge. Clopidogrel (75 mg) and atorvastatin (20 mg) were administered orally to treat acute ischemic stroke. After 12 days of treatment, he can walk normally and communicate with near fluent language. We report an even more unusual case, a patient who was hospitalized for right limb weakness and was later diagnosed with COVID-19. Here, SARS-CoV-2 infection caused hypoxemia and excessive secretion of inflammatory cytokines, which contribute to the occurrence and development of ischemic stroke. Once COVID-19 patients show acute ischemic stroke, neurologists should cooperate with infectious disease doctors to help patients.