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The authors present the case of a patient with preexisting breast cancer, anemia, and thrombocytopenia who was receiving chemotherapy and developed malignant edema of a posterior right acute ischemic stroke. The patient had dyspnea prior to presentation and was positive for SARS-CoV-2. The infarction was 22 mL on initial CT with recanalization on CT angiography. On post-stroke day 4 she developed acute hypoxia and hypercarbia, with abrupt catastrophic neurologic decline.
The authors note that patients with SARS-CoV-2 infection and acute ischemic stroke may be very sensitive to cerebral vasodilation in the setting of acute respiratory distress syndrome. Neurologists should be aware of the potential for rapid neurologic decline in these patients.
– Kyle Binder, MD
This abstract is available on the publisher's site.
SARS-CoV-2 infection has been associated with ischemic stroke as well as systemic complications such as acute respiratory failure; cytotoxic edema is a well-known sequelae of acute ischemic stroke and can be worsened by the presence of hypercarbia induced by respiratory failure. We present the case of a very rapid neurologic and radiographic decline of a patient with an acute ischemic stroke who developed rapid fulminant cerebral edema leading to herniation in the setting of hypercarbic respiratory failure attributed to SARS-CoV-2 infection. Given the elevated incidence of cerebrovascular complications in patients with COVID-19, it is imperative for clinicians to be aware of the risk of rapidly progressive cerebral edema in patients who develop COVID-19 associated acute respiratory distress syndrome.