Multiple strokes as complications of SARS-CoV-2 interstitial pneumonia

ABSTRACT

Background: SARS-CoV-2 infection is a respiratory pandemic illness whose linking with thromboembolic complications has been underlined. Sometimes, stroke can be a complication in CoViD- 19 patients. Description of the case A 62-year-old male came to our attention after a week of asthenia, fever, nausea, dry cough;no cardiovascular risk factors nor other diseases were reported in his clinical history. An RT-PCR test for SARS-CoV-2 was positive. A chest X-Ray showed bilateral pneumonia with widespread interstitial involvement. He was immediately treated with dexamethasone, low molecular weight heparin and oxygen therapy. Because of desaturation (pO2 38.2 mmHg) non-invasive ventilation - CPAP was started, associated to prone positioning. After two days of initial good response with NIV, the patient was found unresponsive with respiratory acidosis (pH 7.25, pCO2 69 mmHg). He was then intubated and centralised to the Intensive Care Unit;there, trying to extubate the patient because of the respiratory improvement, he was still unresponsive. A brain CT scan found multiple supra and subtentorial strokes, even involving the encephalic trunk, with secondary hydrocephalus. An epiaortic CT angio scan showed occlusion of carotid siphons, vertebral arteries and Willis' polygon. The patient, unresponsive with mydriasis and areflexic, tetraplegic, was diagnosed with cerebral death. Conclusions: Thromboembolic complications in SARS-CoV-2 interstitial pneumonia, even in patients without comorbidities or cardiovascular risk factors, can result as strokes with high morbidity and mortality.