key: cord-0895058-xvig5c0m
authors: Quenzer, Faith; Smyres, Cameron; Tabarez, Norma; Singh, Sukhdeep; LaFree, Andrew; Tomaszewski, Christian; Hayden, Stephen R.
title: Large cerebellar stroke in a young COVID-19 positive patient
date: 2021-02-09
journal: J Emerg Med
DOI: 10.1016/j.jemermed.2021.02.004
sha: aeb146ba348df6cb81b26e8f8a10f5e2334b0208
doc_id: 895058
cord_uid: xvig5c0m

Background Coronavirus Disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most frequently presents with respiratory symptoms such as fever, dyspnea, shortness of breath, cough, or myalgias. There is now a growing body of evidence that demonstrates that severe SARS-CoV-2 infections can develop clinically significant coagulopathy, inflammation, and cardiomyopathy, which have been implicated in COVID-19 associated cerebrovascular accidents (CVAs). Case Report We report an uncommon presentation of a 32-year-old man who sustained a large vessel cerebellar stroke associated with a severe COVID-19 infection. He presented with a headache, worse than his usual migraine, dizziness, rotary nystagmus, and dysmetria on exam but had no respiratory symptoms initially. He was not a candidate for thrombolytic therapy or endovascular therapy and was managed with clopidogrel, aspirin, and atorvastatin. During hospital admission he developed COVID-19 related hypoxia and pneumonia, but ultimately he was discharged to home rehabilitation. Why Should an Emergency Physician Be Aware of This? We present this case to increase awareness among emergency physicians of the growing number of reports of neurological and vascular complications such as ischemic CVAs in otherwise healthy individuals who are diagnosed with SARS-CoV-2 infection. A brief review of the current literature will help elucidate possible mechanisms, risk factors, and current treatments for CVA associated with SARS-CoV-2.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the primary 24 cause of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic. COVID-19 most 25 frequently presents with respiratory symptoms such as fever, dyspnea, cough, or myalgias. 1

There is now mounting evidence that demonstrates that SARS-CoV-2 infections can give rise to 27 a wide range of neurological symptoms. These include headache, seizures, dizziness, ataxia, However, strokes have also been observed in patients diagnosed with COVID-19. [2] [3] [4] [5] 7 33 Observational research has demonstrated that SARS-CoV-2 infection has been associated with a 34 coagulopathic state and a variety of prothrombotic sequelae. [8] [9] [10] [11] [12] [13] [14] We report an unusual case of a 35 large cerebellar CVA in a young man who presented to a community emergency department 36 (ED) with a headache and dizziness and without initial respiratory symptoms that are typical of drug screen was negative for opiates and illicit drugs. A computerized tomography scan of the head (CT head) without contrast was performed.

Prior to the final read of the CT head without contrast, the tele-neurology service was 71 also consulted due to the patient's vertigo, ataxia, and rotary nystagmus. The patient was treated White blood cell count (WBC) from admission

RECURRENT ISCHEMIC STROKES IN A 366 PATIENT WITH SEVERE COVID-19 INFECTION AND PHOSPHATIDYLSERINE

COVID-19-Related Stroke. Translational Stroke 369 Research

Understanding the neurotropic characteristics of SARS-CoV-371 2: from neurological manifestations of COVID-19 to potential neurotropic mechanisms

Coronavirus 374 Disease 2019 and the Cerebrovascular-Cardiovascular Systems: What Do We Know So 375 Far

Large-Vessel Stroke as a Presenting Feature of Covid-19 377 in the Young

ISTH interim guidance 379 on recognition and management of coagulopathy in COVID-19

Migraine and risk of stroke