Healthcare Worker With Large Vessel Acute Ischemic Stroke Likely Related to Mild SARS-CoV-2 Infection

• Published in: Neurohospitalist Vol. 12; no. 1; pp. 48 - 56
• Main Authors: Castillo-Pinto, Carlos, Lamotte, Guillaume, Mehta, Amit, Sonti, Rajiv, Di Maria, Gianluca, Ruiz, Daniel, Kumar, Princy N., Stemer, Andrew B., Denny, M. Carter
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2022
• Subjects: Short Report; COVID-19; SARS-CoV-2; acute ischemic stroke; thrombectomy; large vessel occlusion; hypercoagulable state; system of care; stroke
• ISSN: 1941-8744; 1941-8752
• DOI: 10.1177/1941874420966845

We report the case of a healthcare worker who presented with a large vessel acute ischemic stroke in setting of a mild SARS-CoV-2 infection and provide a review of the emerging literature on COVID-related stroke. A 43-year-old female presented with right-sided hemiparesis, aphasia and dysarthria. She had a nonproductive of cough for 1 week without fever, fatigue or dyspnea. A CT Head, CT angiography and CT perfusion imaging revealed a M1 segment occlusion of the left middle cerebral artery requiring transfer from a primary to a comprehensive stroke center. A nasopharyngeal swab confirmed SARS-CoV-2 infection prior to arrival at the accepting center. During the thrombectomy a 3 cm thrombus was removed. Thrombus was also evident in the 8 French short sheath during closure device placement so a hypercoagulable state was suspected. Stroke work-up revealed a glycosylated hemoglobin of 8.7%, elevation of inflammatory markers and an indeterminate level of lupus anticoagulant IgM. On discharge home, she had near complete neurological recovery.
This case highlights suspected mechanisms of hypercoagulability in SARS-CoV-2 infection and the importance of optimizing stroke care systems during the COVID-19 pandemic.