28 April 2020

Young people with Covid-19 presenting with strokes

Respiratory distress syndrome is scary enough, but a New England Journal of Medicine article describes young people presenting with major strokes:
We report five cases of large-vessel stroke in patients younger than 50 years of age who presented to our health system in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all five patients. 
Cough, headache, and chills lasting 1 week developed in a previously healthy 33-year-old woman (Patient 1) (Table 1). She then had progressive dysarthria with both numbness and weakness in the left arm and left leg over a period of 28 hours...  
CT angiography showed a partial infarction of the right middle cerebral artery with a partially occlusive thrombus in the right carotid artery at the cervical bifurcation
The table embedded at the link provides clinical data on the five patients, who were age 33, 37, 39, 44, and 49. All of them were screened for other stroke risk factors (smoking, HT, hyperlipidemia, diabetes, a fib, CHF, illicit drug use, and neck trauma). More information at the link.

During this pandemic, the NEJM is dropping the paywall for articles related to Covid-19 and is loosening review criteria to facilitate rapid transmission of information.
To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations for evaluation or treatment. In the interest of timeliness, these reports are evaluated by in-house editors, with peer review reserved for key points as needed.
Readers can browse the Covid-19 publications here.   I plan to link to selected items of interest as time permits.

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