key: cord-0949208-19zqioln
authors: Mantero, Vittorio; Basilico, Paola; Costantino, Gisella; Pozzetti, Ugo; Rigamonti, Andrea; Salmaggi, Andrea
title: Recurrent Transient Ischemic Attack in a Young Patient with COVID-19
date: 2020-07-01
journal: J Clin Neurol
DOI: 10.3988/jcn.2020.16.3.513
sha: c160935602d1fe8f1ea1167052f58a7ba076d697
doc_id: 949208
cord_uid: 19zqioln

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Stroke and other thrombotic events such as acute myocardial infarction and disseminated intravascular coagulation have previously been reported in association with severe acute respiratory syndrome as a consequence of a hypercoagulable state. 4 It is reported that coagulation parameters are altered in patients with COVID-19, so that routine hemostasis tests may be additional useful tools for improving the ability to perform early diagnoses. 5 Severe infection may be a trigger of acute ischemic stroke via the involvement of intravascular events as well as hypoxia.

It was particularly interesting that, unlike previously described stroke patients, our case did not present risk factors for stroke. It is likely that the inflammation cascade is responsible for the thrombotic apposition in a small calcific stenosis of the carotid artery, causing neurological manifestations.

Prophylactic anticoagulant treatment is increasingly being prescribed in COVID-19 patients due to concerns about frequent and severe venous thromboembolic events. 6 In the present patient, antithrombotic therapy (which is effective against arterial thrombotic disease in both the coronary and cerebral districts) paralleled the reduction in the borderlinesignificant carotid stenosis, thereby avoiding the risks inherent in surgery when severe pneumonia is present. We emphasize that a nonaggressive approach with medical therapy alone may be an appropriate choice in the presence of COV-ID-19 pneumonia and TIA due to carotid atherothrombotic disease. Performing an ECD follow-up after 2-4 weeks is important, which in the present case revealed rapid modifica-tion of the atherosclerotic plaque. 

Vittorio Mantero https://orcid.org/0000-0002-1216-9853

The authors have no potential conflicts of interest to disclose.

Neurologic manifestations of hospitalized patients with coronavirus disease

Sars-Cov-2: underestimated damage to nervous system

Neurological manifestations in COVID-19 caused by SARS-CoV-2

Neurological manifestations in severe acute respiratory syndrome

Prominent changes in blood coagulation of patients with SARS-CoV-2 infection

Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19

None.