key: cord-0720706-ehafs7hy
authors: de Sousa, Gustavo Celeira; de Sousa, Thiago Celeira; Sakiyama, Marcelo Akira Kobayashi; da Silva, Jeanne Seabra Negrão Lima; de Jesus Soares de Sousa, Emanuel
title: Vasculitis-related stroke in young as a presenting feature of novel coronavirus disease (COVID19) – case report
date: 2020-07-17
journal: J Clin Neurosci
DOI: 10.1016/j.jocn.2020.07.034
sha: d21e82e5612404c00588cf21a53ddb357f89c485
doc_id: 720706
cord_uid: ehafs7hy

COVID-19 is the disease caused by Novel Coronavirus (SARS-CoV-2) infection and world current main public health problem, due to its easy transmissibility and multiple clinical presentations. The main symptoms reported worldwide are dry cough, dyspnea, and fever, as well as anosmia and ageusia. COVID-19 diagnosis is made with RT-PCR, but many other complementary exams may be used to guide clinical practice, such as Chest Computerized Tomography (CT), showing ground glass opacities; increase in inflammatory markers, as C-Reactive Protein and Erythrocyte Sedimentation Rate; hemogram might show hypoalbuminemia, thrombocytopenia. Severe cases may evolve to thromboembolic and atheroembolic events, leading to stroke, myocardial infarction, pulmonary thromboembolism. Male, 28 years old, went for neurological appointment after presenting episode of intense headache, dysarthria, deviation of lip rhyme on appointment’s eve. Previously healthy, no comorbidities or risk factors. Underwent brain MRI and serum serological analysis. SARS-CoV-2 capacity of affecting brain homeostasis by breaking blood-brain barrier, makes it easier to develop ischemic or inflammatory damage, and invading central nervous system. Neurological symptoms and syndromes are the main consequences of COVID-19 pandemic and must be prevented through adequate clinical management.

COVID-19 is the disease caused by Novel Coronavirus (SARS-CoV-2) infection, which has quickly escalated to a pandemic scenario. Its transmission is mainly through respiratory droplets, allowing the virus to replicate in upper respiratory tract's mucosal epithelium, where it may lead to anosmia and ageusia symptoms; and invade other tissues, as lower respiratory tract, and gastrointestinal system, allowing it to manifest as diarrhea and other gastrointestinal symptoms. However, it is inside lungs where the virus develops the main symptoms of COVID-19, such as dry cough, dyspnea and fever, due to intense inflammatory response, through T CD4 and T CD8 cytotoxic response, leading to lung's 

Ischemic stroke is a disease in which neurological deficit develop for a short period of time due to focal ischemia, due to temporary reduction or stop on brain's blood flow, its main causes are thromboembolism, cardiac arrythmias, and atheroembolism and its risk factors are high blood pressure, diabetes, high LDL cholesterol levels, age, Coronavirus' infection leads to important inflammatory response and cytokine storm, which in more severe cases leads to IDC, causing thromboembolic phenomena and thrombocytopenia [2] [3] [4] . It is still uncertain SARS-CoV-2 capacity of invading certain tissues, but it is known its capacity of affecting brain homeostasis by breaking blood-brain barrier, making it easier to develop ischemic or inflammatory damage, and invading central nervous system.

Neurological symptoms and syndromes have been related worldwideagitation, enhanced tendon reflexes, ankle clonus and Guillain-Barré syndromestrengthens the hypothesis of virus' tropism for central nervous system [3] [4] [5] .

COVID-19 pathophysiology: a review

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Neurologic Features in Severe SARS-CoV-2 Infection