Department of Neurology, Hubei Provincial Hospital of Tradition Chinese Medicine, Wuhan, 430073, Hubei, China.
Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
Diagn Pathol. 2020 Jun 29;15(1):78. doi: 10.1186/s13000-020-00994-0.
The outbreak of a novel coronavirus since December 2019, became an emergency of major international concern. As of June 21, 2020, the SARS-CoV-2 pandemic has caused 8,769,844 confirmed infections with 463,745 fatal cases worldwide. The SARS-CoV-2 outbreak is a major challenge for clinicians. In our clinic, we found a rare case that a COVID-19 patient combined with ischemic stroke.
A 79-year-old man was admitted to the Hubei Provincial Hospital of Traditional Chinese Medicine due to right limb weakness for 1 day and slight cough for 1 week. At presentation, his oxygen saturation was 94.2% on room air and body temperature was 37.3 °C (99.0 °F) with some moist rales. Neurological examination showed right limb weakness, and the limb muscle strength was grade 4. The left leg and arms were unaffected. In addition, runs of speech were not fluent enough with tongue deviation. Laboratory studies showed lymphopenia and eosinophilic granulocytopenia. Chest CT revealed bilateral pulmonary parenchymal ground-glass and consolidative pulmonary opacities, with a peripheral lung distribution. Real-time polymerase chain reaction (RT-PCR) from throat swab sample was positive for SARS-CoV-2 nucleic acid. This patient was treated with antiviral drugs and anti-inflammatory drugs with supportive care until his discharge. Clopidogrel (75 mg) and atorvastatin (20 mg) were administered orally to treat acute ischemic stroke. After 12 days of treatment, he can walk normally and communicate with near fluent language.
We report an even more unusual case, a patient who was hospitalized for right limb weakness and was later diagnosed with COVID-19. Here, SARS-CoV-2 infection caused hypoxemia and excessive secretion of inflammatory cytokines, which contribute to the occurrence and development of ischemic stroke. Once COVID-19 patients show acute ischemic stroke, neurologists should cooperate with infectious disease doctors to help patients.
自 2019 年 12 月以来，新型冠状病毒的爆发成为国际重大关注的紧急事件。截至 2020 年 6 月 21 日，SARS-CoV-2 大流行已在全球范围内导致 8769844 例确诊感染和 463745 例死亡。SARS-CoV-2 爆发对临床医生来说是一个重大挑战。在我们的诊所，我们发现了一例 COVID-19 患者合并缺血性脑卒中的罕见病例。
一名 79 岁男性因右侧肢体无力 1 天，轻微咳嗽 1 周而被湖北省中医院收治。就诊时，患者在室温下的血氧饱和度为 94.2%，体温为 37.3°C（99.0°F），有少许湿啰音。神经系统检查显示右侧肢体无力，肢体肌力为 4 级。左侧腿部和手臂未受影响。此外，言语不流畅伴有舌偏斜。实验室研究显示淋巴细胞减少和嗜酸性粒细胞减少。胸部 CT 显示双侧肺部磨玻璃和实变肺阴影，呈外周肺分布。咽拭子样本的实时聚合酶链反应（RT-PCR）检测 SARS-CoV-2 核酸阳性。该患者接受抗病毒药物和抗炎药物联合支持治疗，直至出院。给予氯吡格雷（75mg）和阿托伐他汀（20mg）口服治疗急性缺血性脑卒中。治疗 12 天后，他可以正常行走，语言交流近乎流畅。
我们报告了一个更不寻常的病例，一名因右侧肢体无力住院后被诊断为 COVID-19 的患者。在这里，SARS-CoV-2 感染导致低氧血症和炎症细胞因子过度分泌，导致缺血性脑卒中的发生和发展。一旦 COVID-19 患者出现急性缺血性脑卒中，神经科医生应与传染病医生合作，帮助患者。
