Temporal Association Between COVID-19 Immunoglobulin-G Antibody Induced Focal Cerebral Arteriopathy and New-Onset Acute Ischemic Stroke in a Pediatric: Is it Causal or Coincidental?

Abstract

Focal cerebral arteriopathies, vasculitis, microangiopathies, coagulopathies, and in-situ microthrombi leading to territorial infarction of neural tissues are some of the most recent instances which are reported as a consequence of the infection caused by the novel coronavirus (SARS-CoV-2). Acute ischemic stroke (AIS) is one of the major neurological manifestations that have been linked with COVID-19. We describe a case of a 5-year-old boy who had an acute-onset of bilateral arm and leg weakness due to a posterior circulatory ischemic stroke that was temporally associated with COVID-19 Immunoglobulin-G antibody-induced cerebral arteriopathies and vasculitis. Laboratory examination was suggestive of elevated D-dimer levels to 3302 ng/ml, elevated C-reactive protein to 10 mg/dl, and elevated fibrinogen levels to 433 mg/dl. He had a negative COVID-19 nasopharyngeal polymerase chain reaction and positive COVID-19 serologies. Focal cerebral arteriopathy and AIS were managed by administering early antithrombotics, steroids, and multivitamins. On routine follow-ups, the patient remained free from new neurological and functional deficits. Although many hypotheses are proposed to explain the causal relationship between the two, it could as well be sheer coincidence.

Keywords

• acute ischemic stroke
• covid-19
• focal cerebral arteriopathy
• immunoglobulin-g