Ischemic stroke in a patient with giant fusiform aneurysm of dolichoectatic basilar artery and Covid-19 infection

Abstract

: Coronavirus disease (Covid-19) can manifest with numerous neurological disorders. We present a case of stroke in a patient with acute intraluminal thrombus in giant basilar tip fusiform aneurysm. A 71- year-old woman with past medical history of arterial hypertension and dilated cardiomyopathy was hospitalized in intensive care unit (ICU) because of decreased consciousness (GCS 6) and a right- sided hemiplegia which occurred twelve hours before admission. Five days earlier she was tested positive for Covid-19. ECG revealed new-onset atrial fibrillation (AF). She was intubated and mechanically ventilated. Brain CT and CT angiography of the head and neck vessels revealed dolichoectatic BA with giant fusiform aneurysm of the tip of BA. BA lumen was partially filled with hyperdense, acute thrombus. Hypodensity of superior cerebellar artery (SCA) irrigation was consistent with acute ischemic stroke. She was treated with low molecular weight heparin, acetylsalicylic acid and corticosteroid therapy. During hospitalization her respiratory function deteriorated, and she died. To our knowledge this is the first case of stroke caused by acute thrombus in a giant tip of the BA aneurysm in patient with Covid-19 infection. It is important to increase prehospital stroke awareness since stroke in patients with Covid-19 is related to worse outcomes, and in appropriate time window can be treated with acute recanalization techniques.