Fatal Large-vessel Cerebrovascular Infarct Presenting With Severe Coronavirus Disease 2019 in a 39-year-old Patient

A Case Report

Nicolas Koslover; Marc Hardwick; Alexander Grundmann; Tamara Levene

Disclosures

J Med Case Reports. 2021;15(538) 

In This Article

Abstract and Introduction

Abstract

Background: Emerging reports are describing stroke in young, otherwise healthy patients with coronavirus disease 2019, consistent with the theory that some of the most serious complications of coronavirus disease 2019 are due to a systemic coagulopathy. However, the relevance of both the severity of coronavirus disease 2019 illness and established vascular risk factors in these younger patients is unknown, as reports are inconsistent.

Case Presentation: Here we describe a 39-year-old white male, who died after presenting simultaneously with a malignant large-vessel cerebrovascular infarct and a critical coronavirus disease 2019 respiratory illness. Doppler ultrasound revealed evidence of carotid plaque thrombosis. Blood tests revealed evidence of undiagnosed diabetes mellitus; however, the patient was otherwise healthy, fit, and active.

Conclusions: This unique case highlights a possible interaction between established risk factors and large-vessel thrombosis in young patients with coronavirus disease 2019, and informs future research into the benefits of anticoagulation in these patients.

Introduction

Current theories postulate that the most serious complications of coronavirus disease 2019 (COVID-19), including multiple reports of cerebrovascular disease,[1] may be secondary to a systemic coagulopathy increasing the risk of thrombosis and the formation of microemboli.[2] This is thought to be a direct consequence of binding of the virus to angiotensin converting enzyme-2 (ACE2) receptors on the endothelial vessel lining,[3] or the development of an antiphospholipid antibody.[4] A small but growing number of reports have now described stroke in younger COVID-19 patients.[5–7] However, conclusions surrounding the effect of established vascular risk factors in these cases are inconsistent. In addition, the relationship with the severity of COVID-19 disease is unclear, as only COVID-19 symptoms were mentioned in those patients not admitted to intensive care. The following case describes a unique scenario not previously reported, and highlights these interactions as crucial areas for further research.

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