Cerebral Infarction in an Elderly Patient with Coronavirus Disease

An 82-year-old man presented with cough and weakness and admitted to our clinic. His body temperature was 38⁰ C, heart rate 93 beats/min, respiratory rate 22 breaths/min, blood pressure 100/60 mmHg, and oxygen saturation 86% (oxygen mask 5 L/min). His blood leukocyte, neutrophil, lymphocyte, D-dimer, fibrinogen, c-reactive protein, ferritin, and procalcitonin levels were 8.56 x 10³/µL, 7.4x10³/µL, 0.62x 10³/µL, 2304 ng/mL, 638 mg/dL, 183 mg/L, 720 ng/mL, and 0.2 ng/mL, respectively. Computed tomography of the thorax revealed a suspected diagnosis of coronavirus disease (COVID-19) (Figure 1). Antiviral (Favipavir 2 x 1600 mg loading, 2 x 600 mg maintenance) and antibacterial (levofloxacin 500 mg/day) therapies were initiated. The patient’s oronasopharyngal swab specimen was positive for severe acute respiratory syndrome coronavirus 2 nucleic acid. Weakness and loss of muscle tone developed in the left arm on day 3 of treatment. Brain diffusion magnetic resonance imaging showed multiple advanced stage infarctions (Figure 2). Enoxaparin 0.5 mg/kg once every 12 hours and acetylsalicylic acid 100 mg 1x1 were added to treatment. The laboratory parameters improved. The patient was discharged on day 20.

FIGURE 1:
Axial section non-contrast computed tomography showing widespread ground-glass opacities and crazy paving patterns in the bilateral lungs (arrows).

FIGURE 2:
Brain diffusion magnetic resonance imaging showing areas of restricted diffusion compatible with hyperintense infarction in the right frontal lobe (A), and hypointense infarction on apparent diffusion coefficient mapping (B) (arrows).

COVID-19 can result in cerebral infarction and death in the elderly^1,2. Anticoagulants are useful in elderly patients with high D-dimer due to the risk of coagulation dysfunction and cerebral infarction³. Thromboembolic complications must be considered in COVID-19 patients with known risk factors and abnormal laboratory findings.

REFERENCES

• ¹
  Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study[J]. Lancet, 2020, 395(10223): 507-13.
• ²
  He J, Cheng G, Xu W, Zhang L, Zeng Z. Diagnosis and treatment of an elderly patient with secondary cerebral infarction caused by COVID-19. Nan Fang Yi Ke Da Xue Xue Bao. 2020 Mar 30;40(3):351-352.
• ³
  Kollias A, Kyriakoulis KG, Dimakakos E, Poulakau G, Stergiou GS, Syrigos K. Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action. Br J Haematol. 2020 Apr 18. doi: 10.1111/bjh.16727. [Epub ahead of print]
  » https://doi.org/10.1111/bjh.16727

Publication Dates

• Publication in this collection
  03 June 2020
• Date of issue
  2020

History

• Received
  14 May 2020
• Accepted
  25 May 2020