J Neurocrit Care.  2022 Jun;15(1):65-68. 10.18700/jnc.220049.

Malignant cerebral infarction after COVID-19 myocarditis in 22-year-old female: a case report

• Lee SH
• Jeong YS
• Kim CH
• Hong JH
• Sohn SI
• Park H

• KMID: 2532003
• DOI: http://doi.org/10.18700/jnc.220049

Abstract

Background
Ischemic stroke is one of the serious neurological complications of coronavirus disease 2019 (COVID-19). However, ischemic stroke can develop secondary complications after cardiac involvement in COVID-19.
Case Report
We report the case of a 22-year-old patient who presented with malignant cerebral infarction 10 months after COVID-19-related myocarditis. A 22-year-old woman was referred to the emergency room because of abnormal mental status changes. She developed heart failure and arrhythmia after COVID-19-related myocarditis. Brain magnetic resonance imaging (MRI) revealed high signal intensity on diffusion-weighted imaging that was indicative of acute cerebral infarction in the left middle cerebral artery (MCA) and left anterior cerebral artery (ACA) territory. In addition, occlusion of both the left MCA and ACA was observed on brain MRI. Craniectomy with therapeutic hypothermia was performed to treat the cerebral edema.
Conclusion
This case suggests that caution is needed in survivors with secondary complications after COVID-19.

Keyword

COVID-19; Myocarditis; Ischemic stroke

Figure

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  Fig. 1. (A) Chest computed tomography showing multifocal consolidation with ground-glass opacities in both lungs. (B) Cardiac magnetic resonance imaging showing a hypertrophied myocardium due to edema (black arrows). (C) Cardiac magnetic resonance imaging showing transmural late gadolinium enhancement (black arrows). (D) Brain magnetic resonance angiography showing the severe stenosis of the left A2 segment of the anterior cerebral artery (ACA; white arrow) and the distal segment of the left middle cerebral artery (MCA; white arrowhead). (E, F) A diffusion-weighted image showing high signal intensity in the left MCA and ACA territory infarction.

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