D-dimer level elevation can aid in detection of asymptomatic COVID-19 presenting with acute cerebral infarction

Umemura, Takeru; Kondo, Hirohisa; Ohta, Hirotsugu; Futatsuya, Koichiro; Mizobe, Takamitsu; Yamamoto, Junkoh

Coronavirus disease 2019 (COVID-19) mainly manifests as a respiratory syndrome, besides causing other complications. Severe COVID-19 may also present with coagulopathy, leading to venous thrombosis and cerebral infarction. Generally, acute stroke is a secondary complication in patients displaying respiratory syndromes. Here, we present a case of acute stroke in an 84-year-old female patient who did not manifest any respiratory symptoms. The patient had no cough or fever before the stroke onset; nevertheless, COVID-19 PCR test was positive. The patient also had markedly elevated serum D-dimer levels. Our findings suggest that coagulopathy can occur even in a patient with asymptomatic COVID-19 infection, and to our knowledge, this is the first report of such a case. We concluded that elevated D-dimer levels can serve as an additional COVID-19 screening tool in stroke patients.