Rajae Alkouh, Manal Merbouh, Ghizlane El Aidouni, Amine Bouabdlaoui, Zaid I, Houssam Bkiyar, Yassine Mabrouk, Brahim Housni
Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.
Oujda Medical Simulation Training Center, Morocco.
Ann Med Surg (Lond). 2021 Nov;71:102912. doi: 10.1016/j.amsu.2021.102912. Epub 2021 Oct 5.
SARS-COV-2 viral infection primarily targets the respiratory system with a clinical picture that varies from simple symptoms to respiratory distress syndrome requiring hospitalization in the intensive care unit; SARS-CoV-2 also has neuro-invasive capabilities and could spread from the respiratory system to the central nervous system. Recently, some patients with COVID-19 have been shown to have neurological symptoms such as headache, anosmia, dysgeusia, dizziness, impaired consciousness, and ischemic stroke.
we describe a case of ischemic stroke as the main presentation of COVID-19 in a 68 years old man with no previous history, without any associated respiratory signs; clinical examination revealed left hemiparesis with dysarthria and left facial paralysis, NIHSS score was at 11, the brain CT scan performed 1h30min later, completed by a brain MRI that came back in favor of right frontal, temporal and parietal ischemic stroke. The decision of thrombolysis was indicated in urgency, and the patient benefited from thrombolysis, which proceeded without incidents; the outcome was favorable with regression of symptoms.Ischemic stroke has been widely described among the thromboembolic complications of COVID-19, but only a few papers have reported it as a primary manifestation of COVID-19.
SARS-COV 2 infection can spread from the respiratory system to the central nervous system, resulting in an inflammatory response and excessive secretion of inflammatory markers, leading to ischemic stroke.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒感染主要侵袭呼吸系统，临床表现从轻微症状到需要入住重症监护病房的呼吸窘迫综合征不等；SARS-CoV-2还具有神经侵袭能力，可从呼吸系统传播至中枢神经系统。最近，一些新冠肺炎患者已被证实出现头痛、嗅觉丧失、味觉障碍、头晕、意识障碍和缺血性中风等神经症状。
我们描述了一例以缺血性中风为新冠肺炎主要表现的病例，患者为一名68岁男性，既往无病史，无任何相关呼吸道体征；临床检查发现左侧偏瘫伴构音障碍和左侧面瘫，美国国立卫生研究院卒中量表（NIHSS）评分为11分，1小时30分钟后进行脑部CT扫描，随后的脑部磁共振成像（MRI）检查结果支持右侧额叶、颞叶和顶叶缺血性中风。紧急情况下决定进行溶栓治疗，患者接受了溶栓治疗，过程顺利；症状消退，预后良好。缺血性中风在新冠肺炎的血栓栓塞并发症中已有广泛描述，但仅有少数论文将其报道为新冠肺炎的主要表现。
SARS-CoV-2感染可从呼吸系统传播至中枢神经系统，引发炎症反应和炎症标志物过度分泌，导致缺血性中风。
