J Korean Med Sci.  2020 Sep;35(35):e324. 10.3346/jkms.2020.35.e324.

Characteristics of Acute Stroke in Patients with Coronavirus Disease 2019 and Challenges in Stroke Management during an Epidemic

• Kwon DH
• Do Y
• Eun MY
• Lee J
• Park H
• Sohn SI
• Hong JH

• KMID: 2506090
• DOI: http://doi.org/10.3346/jkms.2020.35.e324

Abstract

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic infection associated with high morbidity and mortality. The Korean city of Daegu endured the first large COVID-19 outbreak outside of China. Since the report of the first confirmed case in Daegu on February 18, 2020, a total of 6,880 patients have been reported until May 29, 2020. We experienced five patients with ischemic stroke and COVID-19 during this period in four tertiary hospitals in Daegu. The D-dimer levels were high in all three patients in whom D-dimer blood testing was performed. Multiple embolic infarctions were observed in three patients and suspected in one. The mean time from stroke symptom onset to emergency room arrival was 22 hours. As a result, acute treatment for ischemic stroke was delayed. The present case series report raises the possibility that the coronavirus responsible for COVID-19 causes or worsens stroke, perhaps by inducing inflammation. The control of COVID-19 is very important; however, early and proper management of stroke should not be neglected during the epidemic.

Keyword

Ischemic Stroke; Coronavirus Disease; Korea; Stroke Management; D-dimer

Figure

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  Fig. 1 Radiologic findings of the patients.(A) Patient 2. Diffusion-weighted brain MRI showed acute infarction in the right MCA territory. (B) Patient 3. Brain computed tomography showed multiple hypodense lesions in both the MCA and left posterior cerebral artery territories. (C) Patient 4. Diffusion-weighted brain MRI showed acute multiple embolic infarction in the left MCA territory. (D) Patient 5. Diffusion-weighted brain MRI showed acute multiple embolic infarction in the left MCA territory along with artifacts.MRI = magnetic resonance imaging, MCA = middle cerebral artery.

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