Middle cerebral artery territory infarction in a COVID-19 patient: a case report

Authors

  • Rizaldy Pinzon Duta Wacana Christian University School of Medicine, Yogyakarta, Indonesia; Bethesda Hospital, Yogyakarta, Indonesia
  • Vincent Ongko Wijaya Duta Wacana Christian University School of Medicine, Yogyakarta, Indonesia; Bethesda Hospital, Yogyakarta, Indonesia https://orcid.org/0000-0001-7147-851X
  • Dessy Paramitha Duta Wacana Christian University School of Medicine, Yogyakarta, Indonesia; Bethesda Hospital, Yogyakarta, Indonesia https://orcid.org/0000-0003-1738-3442

DOI:

https://doi.org/10.13181/mji.cr.204707

Keywords:

case reports, COVID-19, ischemic stroke, middle cerebral artery

Abstract

Coronavirus disease 2019 (COVID-19) mainly invades the respiratory system, yet previous reports have shown unusual manifestations of COVID-19, including cerebrovascular events. However, detailed case reports are still lacking. A 57-year-old male presented with sudden unconsciousness and right side lateralization for 6 hours before hospital admission. His test results were positive for severe acute respiratory syndrome coronavirus 2 infection. The head computed tomography (CT) scan showed infarction within the middle cerebral artery region. The scan was repeated 48 hours after admission and showed a massive infarct in the left hemisphere with hemorrhagic transformation. A chest CT showed the appearance of bronchopneumonia with ground-glass opacities in both lungs. The patient's condition was rapidly deteriorating, and he died on the third day after admission. Our findings suggest that ischemic vascular events may simultaneously develop due to the progression of COVID-19. A hypercoagulable state and vascular endothelial dysfunction have been proposed as complications of COVID-19 and are risk factors of thrombotic vascular events.

Downloads

Download data is not yet available.

Author Biography

Rizaldy Pinzon, Duta Wacana Christian University School of Medicine, Yogyakarta, Indonesia; Bethesda Hospital, Yogyakarta, Indonesia

Department of Neurology, Head of Department

References

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13)1199-207. https://doi.org/10.1056/NEJMoa2001316

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5

Indonesian Task Force for COVID-19. Data of COVID-19 in Indonesia [Internet]. Indonesian Task Force for COVID-19; 2020 [cited 2020 Jul 14]. Available from: https://covid19.go.id/petasebaran.

Pinzon RT, Wijaya VO, Buana RB, Al Jody A, Nunsio PN. Neurologic characteristics in coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Front Neurol. 2020;11:565. https://doi.org/10.3389/fneur.2020.00565

Walcott BP, Miller JC, Kwon CS, Sheth SA, Hiller M, Cronin CA, et al. Outcomes in severe middle cerebral artery ischemic stroke. Neurocrit Care. 2014;21(1):20-6. https://doi.org/10.1007/s12028-013-9838-x

Tunç A, Ünlüba? Y, Alemdar M, Akyüz E. Coexistence of COVID-19 and acute ischemic stroke report of four cases. J Clin Neurosci. 2020;77:227-9. https://doi.org/10.1016/j.jocn.2020.05.018

Trejo Gabriel y Galán JM. Stroke as a complication and prognostic factor of COVID-19 [Ictus comocomplicación y como factor pronóstico de COVID-19] Neurología (English Edition). 2020;35(5):318-22. https://doi.org/10.1016/j.nrleng.2020.04.013

Belani P, Schefflein J, Kihira S, Rigney B, Delman BN, Mahmoudi K, et al. COVID-19 is an independent risk factor for acute ischemic stroke. AJNR Am J Neuroradiol. 2020;41(8):1361-4. https://doi.org/10.3174/ajnr.A6650

Zhai P, Ding Y, Li Y. The impact of COVID-19 on ischemic stroke: a case report. Infect Dis [Preprint]. 2020 [cited 2020 May 25]. A vailable from: h ttps://10.21203/rs.3.rs-20393/v1. https://doi.org/10.21203/rs.3.rs-20393/v1

Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-vessel stroke as a presenting feature of covid-19 in the young. N Eng J Med. 2020;382(60):e60. https://doi.org/10.1056/NEJMc2009787

Beyrouti R, Adams ME, Benjamin L, Cohen H, Farmer SF, Goh YY, et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry. 2020;91(8):889-91. https://doi.org/10.1136/jnnp-2020-323586

Zhang ZL, Hou YL, Li DT, Li FZ. Laboratory findings of COVID-19: a systematic review and meta-analysis. Scand J Clin Lab In vest. 2020;1-7. https://doi.org/10.1080/00365513.2020.1768587

Reddy ST, Garg T, Shah C, Nascimento FA, Imran R, Kan P, et al. Cerebrovascular disease in patients with COVID-19: a review of the literature and case series. Case Rep Neurol. 2020;12(2):199-209. https://doi.org/10.1159/000508958

Hartmann P, Schober A, Weber C. Chemokines and microRNAs in atherosclerosis. Cell Mol Life Sc. 2015;72(17):3253-66. https://doi.org/10.1007/s00018-015-1925-z

Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-tolymphocyte ratio predicts severe illness patients with 2019 novel coronavirus in the early stage. J Transl Med. 2020;18:206. https://doi.org/10.1186/s12967-020-02374-0

Wouters A, Nysten C, Thijs V, Lemmens R. Prediction of outcome in patients with acute ischemic stroke based on initial severity and improvement in the first 24 h. Front Neurol. 2018;9:308. https://doi.org/10.3389/fneur.2018.00308

Zhang J, Yang Y, Sun H, Xing Y. Hemorrhagic transformation after cerebral infarction: current concepts and challenges. Ann Transl Med. 2014;2(8):81. https://10.3978/j.issn.2305-5839.2014.08.08

Tsivgoulis G, Katsanos AH, Ornello R, Sacco S. Ischemic stroke epidemiology during the COVID-19 pandemic: navigating uncharted waters with changing tides. Stroke. 2020;51(7):1924-6. https://doi.org/10.1161/STROKEAHA.120.030791

Sweid A, Hammoud B, Bekelis K, Missios S, Tjoumakaris SI, Gooch MR, et al. Cerebral ischemic and hemorrhagic complications of coronavirus disease 2019. Int J Stroke. 2020;1747493020937189. https://doi.org/10.1177/1747493020937189

Yu B, Li X, Chen J, Ouyang M, Zhang H, Zhao X, et al. Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis. J Thromb Thrombolysis. 2020;1-10. https://doi.org/10.1007/s11239-020-02171-y

Zhao J, Li H, Kung D, Fisher M, Shen Y, Liu R. Impact of the COVID-19 epidemic on stroke care and potential solutions. Stroke. 2020;51:1996-2001. https://doi.org/10.1161/STROKEAHA.120.030225

Published

2020-11-14

How to Cite

1.
Pinzon R, Wijaya VO, Paramitha D. Middle cerebral artery territory infarction in a COVID-19 patient: a case report. Med J Indones [Internet]. 2020Nov.14 [cited 2024Nov.21];30(1):66–70. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/4707

Issue

Section

Case Report/Series
Abstract viewed = 1155 times