A Unique Case of Concomitant Acute Arterial Stroke and Dural Venous Thrombosis as Initial Presentation in a COVID Positive Patient
Speaker Credentials
MD
Format
Poster
Start Date
6-11-2020 11:30 AM
End Date
6-11-2020 11:45 AM
Abstract
Introduction:The 2019 coronavirus (COVID-19) can cause severe organ dysfunction and death. COVID-19 is associated with a high risk of thrombotic complications such as arterial and venous thrombosis.The proposed mechanism includes systemic inflammation and endothelial damage, both known stroke risk factors. Although there has been prior cases of isolated arterial strokes or venous sinus thrombosis in these patients, here we report a unique case of simultaneous arterial ischemic stroke and dural venous thrombosis as initial presentation in a COVID positive patient(1). Case: A 64 yo female with a past medical history of hypertension presented with left sided hemiparesis, facial drop and SOB. Labs showed hypoxemia, elevated D dimers and a +COVID test. CT Brain demonstrated a large right middle cerebral artery infarct. CT angio head/neck showed a thrombus on the right internal carotid artery bulb and thrombus on the dural venous sinuses. Chest radiograph showed multifocal pneumonia. Discussion: COVID-19 has had a dramatic impact on the health care systems. Coagulopathy in the form of venous and arterial thromboembolism associated with ischemic stroke, is one of the most severe sequela of the disease. Postulated mechanisms include a severe inflammatory response that disrupts the renin-angiotensin system and alters the coagulation cascade. Theoretically, potential treatments include halting viral replication or targeting ACE2 receptors.We highlight the urgent need to understand the pathogenesis of hyper coagulability in the neurology of this pandemic with the aim to find better treatment targets and reduce its morbidity and mortality(2).
A Unique Case of Concomitant Acute Arterial Stroke and Dural Venous Thrombosis as Initial Presentation in a COVID Positive Patient
Introduction:The 2019 coronavirus (COVID-19) can cause severe organ dysfunction and death. COVID-19 is associated with a high risk of thrombotic complications such as arterial and venous thrombosis.The proposed mechanism includes systemic inflammation and endothelial damage, both known stroke risk factors. Although there has been prior cases of isolated arterial strokes or venous sinus thrombosis in these patients, here we report a unique case of simultaneous arterial ischemic stroke and dural venous thrombosis as initial presentation in a COVID positive patient(1). Case: A 64 yo female with a past medical history of hypertension presented with left sided hemiparesis, facial drop and SOB. Labs showed hypoxemia, elevated D dimers and a +COVID test. CT Brain demonstrated a large right middle cerebral artery infarct. CT angio head/neck showed a thrombus on the right internal carotid artery bulb and thrombus on the dural venous sinuses. Chest radiograph showed multifocal pneumonia. Discussion: COVID-19 has had a dramatic impact on the health care systems. Coagulopathy in the form of venous and arterial thromboembolism associated with ischemic stroke, is one of the most severe sequela of the disease. Postulated mechanisms include a severe inflammatory response that disrupts the renin-angiotensin system and alters the coagulation cascade. Theoretically, potential treatments include halting viral replication or targeting ACE2 receptors.We highlight the urgent need to understand the pathogenesis of hyper coagulability in the neurology of this pandemic with the aim to find better treatment targets and reduce its morbidity and mortality(2).