SARS-COV-2 INFECTION WITH PNEUMONIA AND STROKE
1 Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad
A 67-year-old male, known case of DM, HTN, IHD, smoker, a doctor by profession, presented to ER with the complaint of shortness of breath (SOB) with a mild cough and low-grade fever (undocumented). His neurological examination was normal but systemic examination revealed bilateral coarse crepitations on chest auscultation. He was taken over by the isolation ward after PCR confirmed the SARS CoV-2 infection. Though, he was received in a relatively promising condition and remained static till his 4th day of admission; when his GCS suddenly deteriorated to 10/10 (E4M6V0) with aphasia and left-sided hemiparesis with ipsilateral plantar up-going, unable to maintain saturation on room air so was immediately put on oxygen. Immediate CT-Brain was planned which turned out to be consistent with an acute right middle cerebral artery infarct- Right MCA dot sign (hyperdense Sylvian fissure). A repeat CT scan of the brain was carried out on the 6th day of admission since his GCS dropped to 6/15 which demonstrated Total Anterior Circulation Infarct (TACI). Despite all the possible doctoring and medical care, the patient could not cope up with his life and breathed his last on the 10th day of admission.
A study conducted revealed that the percentage of people developing stroke, later in the disease course of Covid-19 is 5.7%. PCR confirmed SARS-CoV-2 has been detected from CSF of Covid-19 positive patients. Yet another study reported to have a 5% incidence of stroke amidst Covid-19 patients, within 2 weeks from the day of onset of disease, but usually amongst those having a severe form of the disease and other known comorbidities like HTN, IHD, and DM. In the pathophysiology of stroke, the main contributory role seems to be played by the higher inflammatory state and the abnormal coagulation cascade, depicted clinically by raised CRP and D-dimers. Angiotensin-converting enzyme-2 (ACE-2) receptors provide the main door-way to all the coronaviruses including SARS-CoV-2. And thence, SARS-CoV-2 can get an entry into the CNS through these receptors and several other means as well, that might include hypoxic immune-related injury or direct injury to the blood-brain barrier.