Common Carotid Artery Occlusion in a Young Patient: Can Large-Vessel Stroke Be the Initial Clinical Manifestation of Coronavirus Disease 2019?

Abstract

Background The occurrence of large-vessel occlusion in young patients with coronavirus disease 2019 (COVID-19) infection has been exceedingly rare. An extensive review of reported studies revealed a few reported cases. In the present report, we have described the clinical presentation, radiological findings, and outcome of large-vessel occlusion in a young patient with COVID-19 and reviewed the pertinent reported data on this condition. Case Description A 31-year-old woman was in her usual state of health until she had presented with a 3-day history of right-sided weakness, slurred speech, and decreased vision. The patient had been taken to several hospitals where she had been treated conservatively with analgesics and discharged. Shortly thereafter, her weakness had become progressive. She had become severely dysarthric and unresponsive. On arrival to the emergency department, her physical examination revealed that she was stuporous, with a Glasgow coma scale of 10 (eye response, 3; verbal response, 2; motor response, 5). The National Institutes of Health Stroke Scale score was 19 on presentation. Brain computed tomography and computed tomography venography revealed an occluded left internal carotid artery and left middle cerebral artery with subacute left middle cerebral artery territory infarction and midline shift. Computed tomography angiography revealed complete occlusion of the left common carotid artery. An emergent decompressive craniectomy was successfully performed. The patient was shifted to the intensive care unit. She was later found to be positive for COVID-19. Conclusions Although rare, patients with COVID-19 can present with large-vessel occlusion. Prompt identification of COVID-19–related coagulopathy is essential to assess young patients with clinical manifestations of infarction.

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review

“…This was the result of the inflammatory response and cytokine storm, which has also been considered as an important phenomenon for cardiac events in our review (Figure 2 ). Similarly, Alkhaibary et al [ 181 ] reported complete occlusion of the left common carotid artery and left middle cerebral artery of the COVID-19 patients.…”

Symptomatic Common Carotid Free-Floating Thrombus in a COVID-19 Patient, Case Report and Literature Review

“…( Table I ). Another 2 COVID-19 patients with CCA totally occluded have been published, 22 , 23 these cases were excluded from the review because they did not meet our inclusion criteria. All patients presented with stroke as the chief symptom, and COVID-19 manifestations of mild severity.…”

Case Report: Decompressive Craniectomy for COVID-19 Malignant Cerebral Artery Infarction. Is Surgery a Good Option?

“…Roy et al ( 19 ) described a case who received surgical treatment 9 h after the stroke, unfortunately, the patient developed refractory hypoxemia in the postoperative period due to extensive pulmonary embolus and died. Alkhaibary et al ( 20 ) described a case presenting with a left common carotid artery complete occlusion and underwent surgery at least 72 h after worsening. All cases except the one presented by Alkhaibary et al ( 20 ) were treated according to the AHA/ASA 2018 Stroke Guidelines (48 h).…”

“…Alkhaibary et al ( 20 ) described a case presenting with a left common carotid artery complete occlusion and underwent surgery at least 72 h after worsening. All cases except the one presented by Alkhaibary et al ( 20 ) were treated according to the AHA/ASA 2018 Stroke Guidelines (48 h). In our case, although the patient was admitted to the hospital after 3 days of a low level of consciousness, we support the decision of the surgery as the patient was a 31-year-old previously healthy woman.…”