Acute ischemic stroke in a patient with gastrointestinal complaints of COVID-19 infection

Abstract

The most important pandemic in the last century triggered by SARS-CoV-2 infection is ongoing, and longterm implications are still unknown. We report the case of a 65-year old man, who presented with sudden onset of right-sided limb weakness, facial asymmetry, and dysarthria, accompanied by vomiting and headache. The initial neurological exam suggested acute stroke, although the cerebral CT-scan was not relevant neither recent ischemic, nor haemorrhage findings. According to the therapeutic protocol, intravenous thrombolytic therapy was timely administered, with a neurofluctuating course. The infusion was premature interrupted due to the sudden hematemesis, following by concurrent diarrhoea, abdominal cramps and recurrent vomiting. The new cerebral imaging confirmed the acute ischemic stroke in the vertebrobasilar territory and the abdominal CT-exam displayed an inflammatory aspect inflammation surrounding the right kidney and the proximal colon, minimal right pleural effusion and hypo-ventilated areas in the pulmonary bases. The laboratory work-up revealed mild leukocytosis with neutrophilia, increased levels of D-dimers, altered renal function. Considering the epidemic COVID-19, a RT-PCR test for SARS-CoV-2 have been request and, surprisingly, it was positive. Previous unknown paroxysmal atrial fibrillation was found at admission by electrocardiography, suggesting the cardioembolic nature of the ischemic stroke, while a favouring role of infection is possible. The subsequent evolution was positive, following by the secondary prevention with oral anticoagulation, along with hypotensive and statin medication. Apart from the respiratory affection, COVID-19 infection can be present in patients with other major medical emergencies, including acute stroke, with no apparent sign of infection. Additional signs of gastrointestinal affection, along with attentive evaluation of abdominal CT-scan represent important hints for concomitant SARS-CoV-2 infection.

Keywords

• covid-19
• ischemic stroke
• thrombolysis
• diarrhoea