ABSTRACT
A man in his early 40s with no significant vascular risk factors was managed within a period of 6 months for recurrent vascular events: ischaemic stroke, transient ischaemic attack and isolated third nerve palsy. He was extensively investigated throughout the course of illness. The only potential aetiological factor identified was a positive janus kinase 2 (JAK 2) mutation after screening on account of mildly elevated platelet count noted during his most recent admission. Bone marrow aspiration confirmed essential thrombocythaemia. He was started on hydroxycarbamide and has remained relatively symptom free since then.This case reiterates the known associations between thrombosis and JAK 2 mutation even without overt myeloproliferative neoplasms. It also highlights the need for specialists in stroke to consider screening for JAK 2 mutation in a young patient with cryptogenic stroke with or without polycythemia or thrombocytosis.
Subject(s)
Brain Ischemia , Ischemic Attack, Transient , Neoplasms , Oculomotor Nerve Diseases , Stroke , Adult , Humans , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/etiology , Janus Kinase 2/genetics , Male , Stroke/diagnosis , Stroke/etiologyABSTRACT
A 19-year-old man was admitted with a 2-week history of continuous cough along with a day history of acute onset unsteadiness and hiccups. Given the current pandemic, he was initially suspected to have COVID-19, however he tested negative on two occasions. Subsequent brain magnetic resonance imaging (MRI)confirmed a small left acute and subacute lateral medullary infarction with chest X-ray suggesting aspiration pneumonia with right lower lobe collapse. This is a distinctive case of posterior circulation stroke presenting with a new continuous cough in this era of COVID-19 pandemic. We anticipate based on MRI findings that his persistent cough was likely due to silent aspiration from dysphagia because of the subacute medullary infarction. It is therefore imperative that healthcare workers evaluate people who present with new continuous cough thoroughly to exclude any other sinister pathology. We should also be familiar with the possible presentations of posterior circulation stroke in this pandemic era.
Subject(s)
COVID-19/diagnosis , Cough/physiopathology , Hiccup/physiopathology , Lateral Medullary Syndrome/diagnostic imaging , Pneumonia, Aspiration/diagnostic imaging , Sensation Disorders/physiopathology , Vertigo/physiopathology , Cough/etiology , Diagnosis, Differential , Diffusion Magnetic Resonance Imaging , Hiccup/etiology , Humans , Lateral Medullary Syndrome/complications , Lateral Medullary Syndrome/physiopathology , Magnetic Resonance Imaging , Male , Pneumonia, Aspiration/etiology , Postural Balance , SARS-CoV-2 , Sensation Disorders/etiology , Vertigo/etiology , Young AdultABSTRACT
A 63-year-old man was admitted with left-sided weakness and subsequent focal seizures following a recent diagnosis of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia in a nearby hospital. He developed status epilepticus and became comatose, requiring intensive care unit admission for invasive ventilation. Imaging done at admission confirmed extensive cerebral venous sinus thrombosis (CVST) with bilateral venous cortical infarcts and acute cortical haemorrhage. No known risk factor for CVST could be identified. He improved with anticoagulation and antiepileptic therapy. He was subsequently transferred to an inpatient rehabilitation facility. Although Coronavirus disease 19 (COVID-19) infection has been previously associated with thrombotic complications, these mostly relate to the pulmonary vasculature. We present this case as a potential association between CVST and COVID-19 infection.
