Late ischemic stroke and brachiocephalic thrombus in a 65-year-old patient six months after COVID-19 infection: A case report

Abstract

BACKGROUND Although it is well established that coronavirus disease 2019 (COVID-19) is associated with inflammation and a prothrombotic state leading to stroke and venous thromboembolism (VTE), the nuances of this association are yet to be uncovered[1]. Many studies link elevations in inflammatory markers to cases of thromboembolism. Most reports of thromboembolism associated with COVID-19 occur in the venous circulation during or just after the initial hospitalization due to COVID-19[2]. It is unclear how long the hypercoagulable effect of COVID-19 lasts. CASE SUMMARY We present a unique case of a 65-year-old-female who presented to her primary care doctor with a sore throat, cough, fatigue, congestion, diarrhea, headache, and anosmia. She tested positive for severe acute respiratory syndrome coronavirus 2 and received a bamlanivimab infusion 9 days later. After recovering from the acute illness, she received the Pfizer-BioNTech COVID-19 vaccine. Months later, she presented to the Emergency Department (ED) complaining of right sided shoulder pain and motor weakness in her left hand while trying to type on a keyboard. On presentation to the ED, her calculated Padua prediction score for risk of VTE was two and inflammatory markers were not elevated. She was found to have a brachiocephalic artery occlusion as well as an ischemic stroke which was treated with heparin. CONCLUSION Kilby KJ et al. Late Hypercoagulability in COVID-19 WJH https://www.wjgnet.com 14 April 25, 2022 Volume 9 Issue 2 This case suggests hypercoagulability due to COVID-19 may extend further than current literature suggests, to at least six months.