Cardio-cerebral infarction, free-floating thrombosis and hyperperfusion in covid-19

• Authors: Sitara Koneru, Emory University; Dinesh Jillella, Emory University; Raul Nogueira, Emory University
• Journal Title: Neurology International
• Volume: Volume 13, Number 2
• Publisher: MDPI | 2021-06-01, Pages 266-268
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/neurolint13020027
• Subjects: Health Sciences, General
• Keywords: COVID-19; neuroimaging; perfusion; stroke; thrombus

Abstract

Cardio-cerebral infarction, which refers to an acute ischemic stroke (AIS) and acute myocardial infarction (AMI) that occur concurrently, is an uncommon phenomenon with a grave prognosis. Intraluminal carotid thrombus (ICT) is an infrequently encountered cause of ischemic stroke and can be associated with an underlying hypercoagulable state. One severe yet prevalent complication of infection with Coronavirus Disease 2019 (COVID-19) is thrombosis from multi-pathway inflammatory responses. Here, we present a unique case of cardio-cerebral infarction, with a free-floating intraluminal thrombus in the left internal carotid artery, in the setting of recent COVID-19 infection, and with the etiology of both events attributed to a COVID-19 hypercoagulable state. CT perfusion imaging also showed an interesting imaging finding of hyperperfusion, which is believed to be a form of dysfunctional cerebral autoregulation.