FATAL CASE OF ACUTE CVA IN A YOUNG PATIENT DUE TO COVID-19

ABSTRACT

SESSION TITLE Medical Student/Resident Critical Care Posters SESSION TYPE Med Student/Res Case Rep Postr PRESENTED ON October 18-21, 2020 INTRODUCTION: Coronavirus disease 2019 (COVID-19) is an illness caused by Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). In late 2019 and 2020 it had become a global pandemic, still ongoing severe morbidity and mortality throughout the world. It usually presents with fever, respiratory symptoms, GI symptoms like most viral prodrome. This disease severity can range from asymptomatic, mild to severe. It has a very complex pathophysiology which is still under investigation and yet to be understood. Our case shows us one of the rare scenarios that covid-19 presentation. CASE PRESENTATION A 41-year-old man with history of seizure disorder, DM-2 and Depression presented to ED via EMS due to acute AMS x 1 day. He started sleeping more, not eating, confused, became non-verbal and only responded by opening eyes. He remained afebrile, tachycardic 115, Normotensive, O2 saturation of 94% on 2l of nasal cannula. On PE non-verbal, not following commands, responds only to pain, had right facial droop, R- sided hemineglect and L- gaze tendency with R- arm plegia. NIHSS score was >12. Initial CTH - acute L-frontal, parietal, temporal, occipital and basal ganglia infarcts with large calcified plaque in L- Internal carotid artery terminus. Covid swab positive, labs lymphopenia 5.9, ferritin 1421, LDH 403, D-dimer 620, CRP 54. CXR showed b/l infiltrates. He was above window period for TPA and received ASA and atorvastatin. MRI of brain showed L-PCA infarct and patchy MCA infarct;MRA L- Internal carotid artery thrombosis with visualization of L-MCA via collateral flow and severe flow restriction to distal left PCA. He was made DNR/DNI with supportive care but progressively worsen with increasing oxygen requirement and dies in 2days. DISCUSSION: Individuals with covid-19 has been presenting with number of coagulation abnormalities. Most likely by causing venous stasis, endothelial damage and hypercoagulable state by changing the circulating prothrombic factors, leading to thromboembolic events. But as of now, it is very unpredictable to assess who is at risk and what symptoms. Even though Elevated D-dimer correlates with increased risk of hypercoagulability some patient with slightly elevated D-dimer can present with massive thrombo-embolic events. CONCLUSIONS: In contrast with traditional presentation, this severe life-threatening viral infection, can involve multi-organs and can cause serious conditions like massive stroke with irreversible neurological damage even in young adults. Professionals and general population must be made aware of this rare presenting symptom, which will help to seek early medical attention. Reference #1 Oxley T, et al "Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young" New England Journal of Medicine 2020;DOI 10.1056/NEJMc2009787. DISCLOSURES No relevant relationships by Moses Bachan, source=Web Response No relevant relationships by Krishna Kamineni, source=Web Response No relevant relationships by Zinobia Khan, source=Web Response No relevant relationships by swetha Nadella, source=Web Response No relevant relationships by Robert Siegel, source=Web Response No relevant relationships by Vijaya Vudathaneni, source=Web Response