Cerebral Infarction in an Elderly Patient with Coronavirus Disease.

An 82-year-old man presented with cough and weakness and admitted to our clinic. His body temperature was 380 C, heart rate 93 beats/min, respiratory rate 22 breaths/min, blood pressure 100/60 mmHg, and oxygen saturation 86% (oxygen mask 5 L/min). His blood leukocyte, neutrophil, lymphocyte, D-dimer, fibrinogen, c-reactive protein, ferritin, and procalcitonin levels were 8.56 x 103/µL, 7.4x103/µL, 0.62x 103/µL, 2304 ng/mL, 638 mg/dL, 183 mg/L, 720 ng/mL, and 0.2 ng/mL, respectively. Computed tomography of the thorax revealed a suspected diagnosis of coronavirus disease (COVID-19) (Figure 1). Antiviral (Favipavir 2 x 1600 mg loading, 2 x 600 mg maintenance) and antibacterial (levofloxacin 500 mg/day) therapies were initiated. The patient’s oronasopharyngal swab specimen was positive for severe acute respiratory syndrome coronavirus 2 nucleic acid. Weakness and loss of muscle tone developed in the left arm on day 3 of treatment. Brain diffusion magnetic resonance imaging showed multiple advanced stage infarctions (Figure 2). Enoxaparin 0.5 mg/kg once every 12 hours and acetylsalicylic acid 100 mg 1x1 were added to treatment. The laboratory parameters improved. The patient was discharged on day 20.

FIGURE 1:

Axial section non-contrast computed tomography showing widespread ground-glass opacities and crazy paving patterns in the bilateral lungs (arrows).

FIGURE 2:

Brain diffusion magnetic resonance imaging showing areas of restricted diffusion compatible with hyperintense infarction in the right frontal lobe (A), and hypointense infarction on apparent diffusion coefficient mapping (B) (arrows).

COVID-19 can result in cerebral infarction and death in the elderly , . Anticoagulants are useful in elderly patients with high D-dimer due to the risk of coagulation dysfunction and cerebral infarction . Thromboembolic complications must be considered in COVID-19 patients with known risk factors and abnormal laboratory findings.