ISCHEMICAL STROKE IN A CHILD AND ITS ASSOCIATION WITH COVID-19 – CASE REPORT
Keywords:
ischemic stroke, COVID-19, PrediatricsAbstract
There is growing evidence for clinically significant neurological complications in adults in the course of COVID-19 pandemic, even in patients under 50 years of age. A wide variety of inflammatory and / or infectious causes can provoke focal neurological symptoms in children, causing symptoms resembling acute ischemic stroke (IS). In the course of the SARS-CoV-2 pandemic, children are more often infected, even with asymptomatic or mild cases of the disease, and there is an increasing number of cases reports, involving COVID-19 associated IS.
Materials: we present a case report of 8 year old child, discharged from pediatrics with diagnosis ischemical stroke and paraclinical evidences for old COVID-19 infection. The patient is consulted with vascular surgeon for precising the anticoagulant treatment.
Case report: 8 year old male, admitted at Pediatrics with symptoms of strong headache and weakness in the left extremities after physical exercise. Parents deny past COVID-19 infection. Neurological status: left hemiparesis with left hippoglossal nerve paresis. Clinical laboratory: whole blood count, biochemistry (including C-reaktive Protein) , Liquor, Haemocoagulation – without deviations. Differential blood count – decreased absolute numer Lymphocites. SARS-CoV-2 PCR – Negative; IgG against SARS-CoV-2: 620,6 IgM (-); Genetic thrombophilia tests – heterozygote in MTFHR and 4G/5G PAI; Factor VIII – 272,9 – 427%. Medical imaging: Magnetic resonance tomography: ischemic stroke in right middle cerebral artery basin in acute phase. Therapy: low weight molecular heparin (LWMH), Citicoline, Piracetam, Omperazole, Manitol, Clindamycin, Amikacin, Aciclovir, Dexametazon,. Therapy after discharge LWMH 2x0,6ml; Citicoline 2x500mg; Piracetam 2x800mg. Discharged with improvement in neurological status. Month and a half after discharge form Pediatrics ward a cerebral angiography is conducted – patient extracranial vessels, occlusion of middle cerebral artery with collateral perfusion from anterior and posterior cerebral artery. One month after the cerebral angiography the patient is consulted with vascular surgeon for Doppler-sonography (DUS) of extracranial vessels and change in anticoagulant therapy. Results and therapy: patient extracranial vessels, LWMH switched to Edoxaban x15mg daily for 6 months.
Discussion: Presented case report demonstrates multisystemic effects of SARS-CoV-2, even in asymptomatic cases.
Conclusion: Asymptomatic cases of COVID -19 need greater attention, especiallywith young and adolescent patients, because of the frequent extrapulmonary manifestations in these cases. The postcovid syndrome has to be addressed more frequently because of the diversity of its symptoms.
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