key: cord-0831354-4m65jba3
authors: Chi Lik Au, Sunny; Ka Li Ko, Callie
title: Comments on Coronavirus Positive Patients Presenting with Stroke-Like Symptoms
date: 2021-03-10
journal: J Stroke Cerebrovasc Dis
DOI: 10.1016/j.jstrokecerebrovasdis.2021.105741
sha: 78e9f57b6fd5d39babfc8deda80bba62070e3fb7
doc_id: 831354
cord_uid: 4m65jba3

nan

Author: Presenting with Stroke-Like Symptoms", [1] it was a case series on stroke presentation over COVID-19 patients. We are particularly interested on patient 10, the one and only one central retinal artery occlusion (CRAO) case secondary to occlusive thrombus in the internal carotid artery (ICA), who was also highlighted by the authors. CRAO is a blinding ocular emergency, and a harbinger of ischemic cerebrovascular stroke. It is the ocular equivalent of an ischemic stroke. [2] As ophthalmologists in the Hyperbaric Oxygen therapy for central Retinal Artery occlusion (HORA) study, [3] we are gathering global data on the incidence and correlation of CRAO with COVID-19. Our tertiary CRAO referral center has treated 15 acute CRAO cases with hyperbaric oxygen therapy (HBOT) under COVID-19 local outbreak, but there were no cases tested positive for SARS-CoV-2 before or after the CRAO episode, mean follow up period was 5 months.

Ocular manifestation of COVID-19 has long been a hot debate and research topic, and there were only 3 case reports for COVID-19 related CRAO, [4, 5, 6] and 1 case of COVID-19 related ophthalmic artery occlusion (OAO), [7] attracts HBOT practitioners' attention, because HBOT is useful only for CRAO, but not OAO as in the case described by Dumitrascu et al. [7] In addition, CRAO is indicated for HBOT during the 4 COVID-19 outbreak as directed by the position statement from European Committee for Hyperbaric Medicine. [8] Alam et al extracted some of the radiological imaging studies and presented them for patient 1, 6, 12, 16 in Figure 1 . [1] However, the radiological imaging for the special and interesting case of patient 10 was not available. In Table 1 Clarification of the difference is essential for treatment implication as HBOT is only effective to CRAO but not OAO. [9] Murchison et al actually presented a similar case before, [6] From our view, the correlation of CRAO and COVID-19 is still of limited evidence despite almost a year of the pandemic. Metabolic diseases such as hypertension, atherosclerosis, diabetes mellitus, obesity etc. are all known risk factors for CRAO, as well as stroke. [10, 11, 12] All the 5 published cases on presumed COVID-19 induced CRAO patients processed these risk factors, [1, 4, 5, 6] with hypertension being the commonest among all. The same pattern was observed in Alam et al case series too. In contrast, large COVID-19 case series did not find CRAO as the ocular manifestations. [13, 14] Hypothetically, the generalized hypercoagulability status of systemic COVID-19 infection should cause bilateral involvement, which was not the case observed so far. [1, 4, 5, 6] These CRAO eyes were most likely coincident on those at risk (metabolic diseases) patients given the prevalence of COVID-19.

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