Case of scattered ischemic stroke secondary to large internal carotid thrombus in setting of COVID infection

ABSTRACT

Objective: NA Background: In the era of the COVID10 pandemic, increasing reports of ischemic strokes in patients who were positive with the infection have been noted. Although the pathophysiology of this is not completely understood, an association with a hypercoagulable state has been surmised with interaction with angiotensin-converting enzyme 2 and endothelial dysfunction. Design/Methods: NA Results: We present a 49-uear-old woman with hypertension, human immunodeficiency virus (HIV), and recent COVID19 infection who presented to the hospital for acute aphasia and right sided weakness. Neuroimaging revealed multiple scatter ischemic infarcts in left parasagittal cerebral hemispheres. Diagnostic workup revealed a large free-floating thrombus in the left common carotid artery. Coagulopathic workup was largely unremarkable. She was initiated on heparin drip to bridge to long term anticoagulation. Clinically, patient's symptoms improved drastically, and she left against medical advice during bridging process. Conclusions: There is growing literature of COVID19 contributing to a hypercoagulable state and increasing the risks of ischemic strokes even in the generally healthier younger population. In our patient, although she had other risk factors contributing to coagulopathy, we believe her acute development of her proximal common carotid artery thrombus was secondary to her recent COVID19 infection. This case contributes to growing body of literature regarding phenomenology and discussion on possible treatment strategies.