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

Deterioration

On the third day following admission, the patient underwent further combined neurological and respiratory deterioration. He required 15 L/minute oxygen to maintain target saturation and became febrile with temperature of 39 °C. He remained tachypneic, tachycardic, and normotensive. The GCS decreased to between 8 and 10, and the left pupil became fixed and dilated. Repeat CT scan was performed (Figure 3) and revealed evidence of a dense left middle cerebral artery (MCA) ischemic infarct with mass effect and 1 cm midline shift to the right, resulting in hydrocephalus and raised intracranial pressure. Neurosurgical intervention was discussed but not considered feasible. The patient was managed conservatively and unfortunately died that evening.

Figure 3.

Computed tomography Brain showing L-sided oedema with mass effect

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