The impact of COVID-19 on ischemic stroke: A case report (preprint)

ABSTRACT

BackgroundThe outbreak of a novel coronavirus since December 2019 in Wuhan, became an emergency of major international concern. As of March 5, 2020, the SARS-CoV-2 epidemic has caused 80,565 confirmed infections with 3,015 fatal cases in China. 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.Case PresentationA 79-year-old man was admitted to the Hubei Provincial Hospital of Chinese Traditional Medicine due to right limb weakness for 1 day and slight cough for 1 week. At presentation, his 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 twelve days of treatment, he can walk normally and communicate with near fluent language.ConclusionWe 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.