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 |