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


J Med Case Reports. 2021;15(538) 

In This Article


In further support for the COVID-19 leading to a prothrombotic state, this patient's COVID-19 related respiratory illness was contemporaneous with his cerebrovascular infarct and mirrored its severity, strongly suggesting a mechanistic relationship. This is consistent with some reports describing stroke in patients managed for COVID-19 in intensive care,[8] but in most reports the temporal relationship is not clear.

The patient was apparently fit and healthy prior to his presentation; however, initial investigations revealed undiagnosed severe diabetes mellitus as well as a deranged lipid profile. Given his age and background, it is unclear whether these factors increased the risk of his large vessel thrombosis through a typical atherosclerotic mechanism. Although established atherosclerotic risk factors are considered important predictors for the severity of COVID-19,[9] available reports have not been able to consistently associate these with large-vessel thrombosis in younger COVID-19 patients.[5–7]

Prospective studies are now needed to further characterize the associations between COVID-19 and cerebrovascular disease and other thrombotic disorders, as well as establish causatively whether and how vascular risk factors might influence the prothrombotic state independently from atherosclerosis. This will enable a crucial quantitative measurement of risk that can inform decisions regarding anticoagulation, which in such young patients with low bleeding risk is likely to be optimal management.