Unprotected stroke management in an undiagnosed case of Severe Acute Respiratory Syndrome Coronavirus 2 infection

J Stroke Cerebrovasc Dis. 2020 Sep;29(9):104981. doi: 10.1016/j.jstrokecerebrovasdis.2020.104981. Epub 2020 May 23.

Abstract

Coronavirus disease 19 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this scenario, managing acute medical conditions, such as stroke, requires a timely treatment together with proper strategies that minimize the risk of infection spreading to health care workers and other patients. We report the case of a 79-year-old woman, who was admitted for a wake-up stroke due to occlusion of the left middle cerebral artery. She was treated outside the COVID-19-dedicated track of the hospital because she had no concomitant signs or symptoms suggestive of SARS-CoV-2 infection nor recent contact with other infected individuals. Post-mortem nasal and pharyngeal swab was positive for SARS-CoV-2 infection. We propose that hyperacute stroke patients should be tested for SARS-CoV-2 infection at admission and then managed as having COVID-19 until cleared by a negative result. We are aware that such measure results in some delay of the acute treatment of stroke, which could be minimal using well-exercised containment protocols.

Keywords: COVID-19; Sars-CoV-2; Stroke; severe acute respiratory syndrome coronavirus 2; stroke management.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Betacoronavirus / isolation & purification*
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques*
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / transmission
  • Coronavirus Infections / virology
  • Delayed Diagnosis
  • Fatal Outcome
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / diagnosis
  • Infarction, Middle Cerebral Artery / physiopathology
  • Infarction, Middle Cerebral Artery / therapy*
  • Infectious Disease Transmission, Patient-to-Professional / prevention & control
  • Nose / virology*
  • Occupational Exposure / adverse effects
  • Pandemics
  • Pharynx / virology*
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / transmission
  • Pneumonia, Viral / virology
  • Predictive Value of Tests
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index