SARS-CoV-2, recurrent ischemic strokes and carotid macrothrombosis: the other face of the cytokine storm (a case report).

Since December 2019, the world has experienced the emergence in China of a new infection called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This infection quickly has progressed to a global pandemic since March 2020, with very high human-to-human transmission rate. Besides lung injury, COVID-19 is also associated with cardio and neurovascular complications. Herein, we report the case of a 77-year-old female who presented with non-severe COVID-19 and multiple ischemic strokes secondary to an extensive carotid thrombosis. The ischemic stroke was supposed to have been caused by the cytokine storm related to COVID-19. The possibility of hemorrhagic transformation, based on the assessment of bleeding score, limited the use of anticoagulation, and probably explained the stroke recurrence and poor outcome in our patient. The pathogenic mechanism and the management of this complex situation are still lacking and further studies are needed.

A unique association of bifacial weakness, paresthesia and vestibulocochlear neuritis as post-COVID-19 manifestation in pregnant women: a case report.

SARS-CoV-2 is an infection due to a novel virus belonging to the coronavirus family. Since December 2019, first human cases of COVID-19 have been identified in Wuhan (China) and rapidly has been progressed to a global pandemic declared by the world health organization (WHO) on March 11th 2020. The major complication of COVID-19, is pneumonia, but other presentations like cardiovascular and neurological complications have been reported. Herein, we report a first case of pregnant women presented with bifacial weakness and paraesthesia (BFP) associated to a vestibulocochlear neuritis as post-COVID-19 manifestation. This is a 36-year-old Moroccan female patient with a history of SARS-CoV-2 positive 6 weeks before admission. She presented to the emergency department with rapid bifacial paralysis, bilateral lower extremity paresthesia, vertigo, nausea, vomiting and right auricular pain. An acute stroke was ruled out after neurological examination and brain MRI. Clinical presentation, neurophysiological, audiometry and videonystagmography workup additionally to CSF findings were suggestive of a variant of Guillain Barré Syndrome (GBS), which is BFP associated to right vestibulocochlear neuritis. The patient was treated with Intravenous immunoglobulins (IVIG) therapy associated with intravenous steroids. The patient made a complete recovery of the right facial palsy and the sensorineural hearing loss but still have tingling in lower limbs and left facial palsy at 2 weeks´ follow-up. BFP can be induced by COVID-19 as a postinfectious immune-mediated complication. Regarding the pathophysiology of vestibular neuritis, is probably similar to other viral infection causing nerve damage. Clinicians should consider the association of vestibulocochlear neuritis and BFP as a post SARS-CoV-2 manifestation.

Personal Protective Equipment and Headaches: Cross-Sectional Study Among Moroccan Healthcare Workers During COVID-19 Pandemic.

Background Healthcare workers in frontline during the coronavirus 19 disease (COVID-19) pandemic are mandated to wear specific personal protective equipment (PPE) including high filtrating masks and/or eye protection during extended period of time. Compressive headaches secondary to PPE use including N95 masks have been reported. We aim to describe subtypes of headache related to PPE use in our hospital in Casablanca and working condition factors associated with it. Methods We conducted a cross-sectional study among healthcare workers in frontline at Cheikh khalifa International University Hospital, using an online questionnaire. We collected demographic data, comorbidities and previous headaches history. Data about working conditions during pandemic, type and duration of PPE use were described. We calculated the prevalence of De Novo or an aggravated headache among healthcare workers. We studied correlations between PPE related headaches and working conditions and trends in PPE use during the pandemic. Finally, we described the overall discomfort related to PPE use. Results A total of 155 healthcare workers responded to the questionnaire. The N95 masks were the most used type (95.5%) associated with an eye protection in 61.3%. The overall prevalence of headache related to PPE was 62%. It was experienced De Novo in 32.9%, while it was an aggravation of pre-existing headache in 29%. Working more than 8 hours per shift during the pandemic was correlated to De novo headache (p = 0.008). The profession of doctor and working more than 12 hours per shift were correlated to aggravated headache (p = 0.02, p = 0.023). Healthcare workers experienced moderate discomfort, blurred vision and reduced concentration. They judged their professional performance mildly reduced by the use of PPE. Conclusion The increased use of PPE, especially high filtrating masks during the COVID-19 outbreak is responsible for generating headaches in healthcare workers on frontline either De novo or as an aggravation of pre-existing one. Working conditions have the greater impact on generating these types of headaches more than any pre-existing comorbidity. These findings should be considered to accommodate health care professionals to increase efficacy and adherence to protective measures during pandemic.

SARS-CoV2 disease seen through the prism of acutely decompensated chronic kidney disease and ischemic stroke: What lesson we have learned from using prophylaxis therapy of vascular thromboembolism?

Our case underlines the tight management of antithrombotic therapy in the context of acutely decompensated chronic kidney disease, ischemic stroke, and SARS-CoV2 infection, the development of stroke as a SARS-CoV2 complication increase the chances of adverse outcomes that may be mitigated by a rapid recognition and institution of available treatments.