Brainstem stroke: A fatal thromboembolic event after new onset atrial fibrillation during covid-19 infection: A case report and literature review

Radiol Case Rep. 2021 Nov;16(11):3244-3249. doi: 10.1016/j.radcr.2021.07.090. Epub 2021 Aug 6.

Abstract

Coronavirus disease (COVID-19) disease is a serious pandemic that put the world on an exceptional sanitary alert. It is a multifaceted disease, since it can affect the lung, the cardiovascular system and the central nervous system at the same time. A 66-year-old man, diabetic, hypertensive, admitted to the emergency room for medical management of acute dyspnea, diagnosed with COVID-19 infection. The evolution is marked by respiratory distress as well as new onset atrial fibrillation and a severe ischemic stroke of the brainstem. COVID-19 disease is associated with very serious thromboembolic complications of high incidence, and this is explained by the coagulopathy secondary to the alteration of the microcirculation after the hyper-inflammatory state. Ischemic stroke is one of these complications. The occurrence of new onset atrial fibrillation during COVID-19 infection makes the incidence of ischemic stroke very high and the prognosis more severe. The treatment is mainly based on antithrombotic therapy. Thromboembolic complications remain a real problem to manage in COVID-19 patients given the several mechanisms that promote this situation.

Keywords: ACE, Angiotensin Converting Enzyme; BMI, Body Mass Index; BP, Blood Pressure; Brainstem; CRP, C-Reactive Protein; CT, Computed Tomography; Coagulopathy; Coronavirus; Covid-19; GCS, Glasgow Coma Scale; HR, Heart Rate; MRI, Magnetic Resonance Imaging; Mechanical Thrombectomy; NIHSS, National Institutes Of Health Stroke Scale; New onset atrial fibrillation; RF, Respiratory Frequency; RT-PCR, Reverse Transcription Polymerase Chain Reaction; Stroke.

Publication types

  • Case Reports