Concluded Case

Acute ischaemic infarct in a covid Patient

30yrs old female president to casualty with fever, dry cough with no shortness of breath for six days and altered level of consciousness, and left sided weakness with sensory loss for two days.Patient was intubated in the casualty for respiratory failure and low GCS. Chief Complaints Fever,dry cough, altered sensorium,left sided weakness. History No relevant medical history present Vitals BP - on norad support,HR -130,RR -32,Spo2 -85,Temp -102°F Physical Examination GCS -8/15,Pupils - Left 4mm RTL,Right 8mm NRTL,Power was 1/5 in both upper and lower extremities on the left side and 4/5 on the right side in both lower and upper extremities. Investigations RT PCR for SARS COV 2 POSITIVE

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Concluded answer

Rt MCA territory ischaemic area in CT head What was onset of weakness on left side ? Acute or insidious? Stroke in covid is not unusual but possibility of encephalitis can also there Even in CT it diffuse patchy hypodensity Although prognosis with adequate care is good Get vascular study both intra cranial and intracranial vessels Get a good quality MRI brain also Pt can started on anti platelet along with standard covid care treatment along with anti epileptics

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CT shows acute infartion rt temporal and adjacent parasagittal area. There is another old infarction left putaminal/ periventricular area. Covid 19 can produce vascular lesions and stroke ,but this 30 yr old young man has another old lesion ,ischemic infarction in the left side MCA branch also. This shows,he has some underling risk factors for stroke. Suggest: MRI brain with MRA,complete work up for young stroke including vasculitis screening,test for thrombophilia including antithrombin 111,protein C ,protein S ,anticardiolipin antibody,fasting homocysteine ,Cardiac evaluation etc. CRP elevated with +D diamer ,ie probably due to COVID 19 infection. Kindly give follow up of this case.

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x-ray chest shows that patient has undergone valvular heart surgery.. this could be bacterial endocarditis with septic emboli and infarct of brain.... covid positive is add on...please look into that..your history doesn't mention that

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Rt MCA territory ischaemic area in CT head What was onset of weakness on left side ? Acute or insidious? Stroke in covid is not unusual but possibility of encephalitis can also there Even in CT it diffuse patchy hypodensity Although prognosis with adequate care is good Get vascular study both intra cranial and intracranial vessels Get a good quality MRI brain also Pt can started on anti platelet along with standard covid care treatment along with anti epileptics

Valuable opinion
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1.Large subacte infarct in rt frontal, temporal and parietal lobes ( in mca and aca territories) with haemorrhagic transformation and mass effect2. stigmata of chronic infarct lt basal ganglia and adjacent temporal lobe

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Treat covid treatment protocol. Rt mca infarct. Take mri for better visualisation. Follow tretment protocol for infarct. Not suitatable for surgical &thrombolysis as on now

Valuable opinion
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Ct angio may help further

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