Internal Medicine, Hurley Medical Center, Flint, Michigan, USA.
Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
BMJ Case Rep. 2021 Feb 23;14(2):e240536. doi: 10.1136/bcr-2020-240536.
COVID-19 is well known for its respiratory symptoms, but severe presentations can alter haemostasis, causing acute end-organ damage with poor outcomes. Among its various neurological presentations, cerebrovascular events often present as small-vessel strokes. Although uncommon, in predisposed individuals, large-vessel occlusions (LVOs) can occur as a possible consequence of direct viral action (viral burden or antigenic structure) or virus-induced cytokine storm. Subtle presentations and complicated stroke care pathways continue to exist, delaying timely care. We present a unique case of COVID-19 LVO manifesting as an acute confusional state in an elderly man in April 2020. CT angiography revealed 'de novo' occlusions of the left internal carotid artery and proximal right vertebral artery, effectively blocking anterior and posterior circulations. Delirium can lead to inaccurate stroke scale assessments and prolong initiation of COVID-19 stroke care pathways. Future studies are needed to look into the temporal relationship between confusion and neurological manifestations.
COVID-19 以其呼吸道症状而闻名，但严重的表现会改变止血功能，导致急性终末器官损伤和不良预后。在其各种神经表现中，脑血管事件常表现为小血管中风。虽然不常见，但在易患个体中，大血管闭塞（LVOs）可能是直接病毒作用（病毒负担或抗原结构）或病毒诱导的细胞因子风暴的结果。微妙的表现和复杂的中风治疗途径仍然存在，导致治疗延误。我们报告了 2020 年 4 月一名老年男性 COVID-19 LVO 表现为急性意识混乱的独特病例。CT 血管造影显示左侧颈内动脉和右侧椎动脉近端“新发”闭塞，有效阻断了前循环和后循环。谵妄可导致不准确的中风量表评估，并延长 COVID-19 中风治疗途径的启动时间。需要进一步研究来探讨意识混乱和神经表现之间的时间关系。
