Acute carotid artery occlusion and stroke in patient with COVID-19

Author: Samira Solh Rached (Algeria)

Co-authors: Tabash Issa, Zouaoui Nadjet

Purpose

34-year-old patient with unbalanced diabetes, consults for a visual loss in the left eye which occurred two months ago concomitantly with a stroke, following an infection with COVID19.

Setting/Venue

Dept. of Ophthalmology, University Oran,Algeria

Methods

When the stroke occurred, the patient was urgently admitted to the neurology department. Brain MRI revealed ischemic stroke. The biological assessment objectified an inflammatory syndrome with hyperferritinemia at 809.5ng / ml, Dimer high at 2.33 ug / ml and an increase in LDH at 653IU / l. Doppler ultrasound of the vessels of the neck revealed an occlusive floating thrombus of the left internal carotid without atheromatous plaque and without carotid dissection. It should be noted that five days before the onset of the stroke , the patient presented with influenza-like illness and was diagnosed with COVID positive with a chest scanner which revealed frosted glass opacities reaching 60% of the parenchyma. pulmonary. A prescription for azithromycin, vitamin C with home confinement was recommended to him.

Results

The patient underwent thrombolysis within three hours of the onset of the stroke but without recanalization of the carotid artery. The patient consulted in ophthalmology two months after the onset of symptoms. The ophthalmologic examination of the right eye was unremarkable. In the left eye: Absence of light perception, areflexic semi-mydriasis, fundus: proliferative retinopathy complicated by stage 1 intravitreal hemorrhage. Fluorescein angiography revealed a delay in choroidal and retinal filling , large areas of retinal ischemia with diffusion of a papillary neovascular membrane. The patient received retinal panphotocoagulation in the left eye for prevention of neovascular glaucoma. An exhaustive etiologic investigation for a disorder of the balance sheet of thrombophilia or system disease was negative, leading to the diagnosis of an occlusion of the left internal carotid in as part of thromboembolic complications of COVID19 infection.

Conlusions

Infection with COVID 19 can be life-threatening and functional due to the occurrence of thromboembolic complications.