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Table 1 Clinical characteristics of the patients

From: A case series of ischemic stroke with coronavirus disease 2019 in two Egyptian centers

 

Age

Gender

Medical history

Stroke presentation

NIHSS on admission and post-r-tPA

COVID-19 severity

Lab results (all patients are COVID-19 PCR positive)

Imaging (brain and chest)

Treatment received

Outcome and mRS

CBC a

Acute phase reactantsb (CRP, ESR, Ferritin, LDH)

D-dimerc

Patient 1

65

Male

o Ex-smoker

o HTN

o AF

o ISH

o BA

OTD 1.5 h

o RT hemiparesis

o RT hemihypesthesia

o RT UMN facial

o Global aphasia

12 and 9

Moderate

HB 16.9 g/dl, WBC 12.6; Lymph. 1.76, neutrophil 10.27, platelet 340

CRP 315 ↑, ESR 10, ferritin 113

1.62 ↑

CT brain: baseline: free, MRI: MCA with hemorrhagic transformation

CT chest: multiple unilateral right lower lung lobe ground glass appearance and small peripheral consolidation patches of intermediate probability for COVID

For stroke: r-tPA

DTN 25 min

For COVID-19: oseltamivir, azithromycin, LMWH

Transfer to isolation unit

Discharged after 20 days

mRS 4

Patient 2

57

Male

o ISH

o HF

o DM

OTD 3 h

o LT hemiparesis

o LT hemihypesthesia

o LT UMN facial

o Partial gaze

o Dysarthria

11 and 7

Severe

HB 15 g/dl, WBC 7.2, Lymph. 0.91↓, neutrophil 5.44, platelet 297

CRP 410↑, ESR 45

2.35↑

CT brain: baseline: free

X-ray chest: bilateral ground glass opacities peripheral and central with high probability of COVID

For stroke: r-tPA

DTN 33 min

For COVID-19: azithromycin, 40 mg steroids

Desaturation and put on oxygen 2 L.

ICU admission and ventilated for 1 day then died.

mRS 6

Patient 3

56

Male

None

OTD 2.5 h

o LT hemiparesis

o LT hemihypesthesia

o Ataxia

o Dysarthria

7 and 4

Moderate

HB 16.1 g/dl, WBC 7.5, Lymph. 0.87↓, neutrophil 5.96, platelet 223

CRP 1071↑, ESR 40

2.16↑

CT brain: baseline: free

CT chest: bilateral scattered central and peripheral ground glass opacities with high probability of COVID

For stroke: r-tPA

DTN 20 min

For COVID-19: LMWH 60 IU, azithromycin, 40 mg steroids

Transfer to ICU isolation unit

mRS 2

Patient 4

52

Male

o Ex-smoker

o ISH,

o History of pulmonary edema

o DM

OTD 1 h

o RT hemiparesis

o RT hemihypesthesia

o RT UMN facial

o Global aphasia

12 and 5

Moderate

HB 14.5 g/dl, WBC 7.5, Lymph. 1.17, neutrophil 5.52, platelet 228

CRP 306↑, ESR 50

1.95↑

CT brain: baseline: free

Follow-up: MCA territorial infarction

CT chest: bilateral central areas of ground glass with mild pulmonary venous congestion with minimal pleural effusion and tiny calcified pleural plagues

For stroke: r-tPA

DTN 30 min

For COVID-19: azithromycin, LMWH, 40 mg steroids

Transfer to isolation unit, discharged later on

mRS 2

Patient 5

74

Female

o DM

o HTN

OTD 3 h

o RT hemiparesis

o RT hemihypesthesia

o RT UMN facial

o Dysarthria

o Inattention

o Diabetic ketosis (RBG 500 placed on insulin pump)

12 and 8

Mild

HB 11.5 g/dl, WBC 8.6, Lymph 1.07, neutrophil 6.37, platelet 312

CRP 120↑, ESR 70, LDH 234↑

2.44↑

CT brain: baseline: free

CT chest: bilateral diffuse basal ground glass appearance and interseptal thickening—indeterminate for COVID

For stroke: r-tPA

DTN 30 min

For COVID-19: azithromycin, oseltamivir

Transferred to isolation unit and discharged home after stabilization

mRS 2

Patient 6

68

Female

o HTN

OTD 3 h

o LT hemiparesis

o LT hemihypesthesia

o LT UMN facial

o Gaze

14 and 6

Mild

HB 12.5 g/dl, WBC 4.3, Lymph. 1.46, neutrophil 2.51, platelet

232

CRP 164↑, ESR 45, ferritin 590.6↑

3.36↑

CT brain: baseline: free

Follow-up: RT parietal and frontal MCA infarction

CT chest: bilateral central patchy areas of ground glass opacity—intermediate probability of Covid-19

For stroke: r-tPA

DTN 35 min

For COVID-19: azithromycin, oseltamivir, full dose LMWH

Transfer to isolation room within department and then to isolation unit—much improved.

mRS 2

Patient 7

59

Male

o DM

OTD 3 h

o RT hemiparesis

o RT hemihypesthesia

o RT UMN facial

o Global aphasia

17 and 15

Severe

HB 12.5 g/dl, WBC 10.7, Lymph. 0.8↓, neutrophil 11, platelet 238

CRP 302.5↑, ESR 55, ferritin 1300↑

1.91↑

CT brain: baseline: free

Follow-up: left MCA infarction

CT chest: bilateral basal ground glass

For stroke: r-tPA

DTN 35 min

Desaturated on room air (So2 66%), intubated and ventilated with ICU admission and died the next day

mRS 6

Patient 8

62

Female

o AF

o ISH

o DM

o HTN

OTD 7 h

o LT hemiparesis

o LT hemihypesthesia

o LT UMN facial

10

Moderate

HB 11 g/dl, WBC 8.7, Lymph. 1.33, neutrophil 6.25, platelet 216

CRP 78↑, ESR 58

1.85↑

MRI brain: right external watershed area

CT chest: 2 small areas with ground glass appearance, mild right and minimal left-sided pleural effusion, low to intermediate left-sided pleural effusion

For COVID-19: chloroquine, oseltamivir, azithromycin, full dose anticoagulation

Transfer to isolation unit and was stable for 12 days

mRS 4

Then sudden deterioration with hemorrhagic transformation

GCS 3

Patient 9

37

Male

o Smoking

o HTN

OTD 24 h

o LT hemiparesis

o LT UMN facial

o Dysarthria

10

Moderate

HB 12.1 g/dl, WBC 9.55, Lymph. 2.36, neutrophil 6.26, platelet 255

CRP 70↑, ESR 63

2.41↑

MRI brain: RT basal ganglion large ischemic infarction

X-ray chest: free except for increased bronchovascular markings

For stroke and COVID-19: antiplatelet then anticoagulation

Discharged and much improved

mRS 1

Patient 10

36

Male

None

OTD 12 h

o Expressive dysphasia

4

Mild

HB 13.1 g/dl, WBC 5.92, Lymph. 2.03, neutrophil 2.92, platelet 273

CRP 38.9↑, ESR 55, ferritin 584.1↑

 

MRI brain: LT insular

Fronto-parietal. Left cerebellar subacute infarction

CT chest: bilateral multilobar multifocal variable-sized patchy and wedge shape ground glass opacities, bilateral lower lobe consolidations shows predominant peripheral distribution—highly suspicious of COVID

For stroke and COVID-19: antiplatelet then anticoagulant

Stable despite suffering acute myocardial infarction after stroke by few days.

mRS 0

  1. HTN hypertension, DM diabetes mellitus, ISH ischemic heart, AF atrial fibrillation, BA bronchial asthma, UMN upper motor neuron, HB hemoglobin, WBC white blood cells, Lymph. lymphocytes, CRP C-reactive protein, ESR erythrocyte sedimentation rate, LDH lactate dehydrogenase, mRS modified Rankin Score, MCA middle cerebral artery, RT right, LT left, OTD onset to door, DTN door to needle, NIHSS National Institute of Health Stroke Scale, LMWH low molecular weight heparin, GCS Glasgow coma scale
  2. aHB = normal value 13–17 g/dl, WBC = normal value 4000–10,000, neutrophils = normal value 2000–7000, lymphocytes = normal value 1000–3000, 20–40%, platelets = normal value 250,000–450,000
  3. bCRP normal value up to 6 mg/l, ESR normal value up 2–20 mm/h, ferritin = normal value 13–150 ng/l, LDH normal value 140–270 IU/l
  4. cD-dimer = normal value up to (0.55 ug/l)