Common Carotid Artery Occlusion in a Young Patient: Can Large-Vessel Stroke be the Initial Clinical Manifestation of COVID-19?

Alkhaibary, Ali; Abbas, Munzir; Ahmed, Muhammad Ejaz; Khatri, Ismail A.; Alkhani, Ahmed

Background The occurrence of large-vessel occlusion in young patients with COVID-19 infection is exceedingly rare. An extensive review of the literature revealed a few reported cases. This article reports the clinical presentation, radiological findings, and outcome of large-vessel occlusion in a young patient with COVID-19 and reviews the pertinent literature on this condition. Case Description A 31-year-old female was in her usual state of health until she presented with a 3-day history of right-sided weakness, slurred speech, and decreased vision. The patient was taken to several hospitals where she was managed conservatively with analgesics. Shortly thereafter, her weakness become progressive. She became severely dysarthric and unresponsive. Upon arrival to the emergency department, her physical examination revealed that she was stuporous, with a Glasgow coma scale (GCS) of 10 (E3 V2 M5). The National Institutes of Health Stroke Scale (NIHSS) score was 19 upon presentation. Brain CT and a CT venogram revealed an occluded left internal carotid artery and left middle cerebral artery (MCA) with subacute left MCA territory infarction and midline shift. A CT angiogram revealed complete occlusion of the left common carotid artery. An emergent decompressive craniectomy was successfully performed. The patient was shifted to the intensive care unit. She was later found to be positive for COVID-19. Conclusion Although rare, patients with COVID-19 can present with large-vessel occlusion. Prompt identification of COVID-19–related coagulopathy is essential to assess young patients with clinical manifestations of infarction.