BMJ Case Reports

Spotlight

Editor's choice article

COVID-19 is well known for its respiratory symptoms, but severe presentations can alter haemostasis, causing acute end-organ damage with poor outcomes. Among its various neurological presentations, cerebrovascular events often present as small-vessel strokes. Although uncommon, in predisposed individuals, large-vessel occlusions (LVOs) can occur as a possible consequence of direct viral action (viral burden or antigenic structure) or virus-induced cytokine storm. Subtle presentations and complicated stroke care pathways continue to exist, delaying timely care. We present a unique case of COVID-19 LVO manifesting as an acute confusional state in an elderly man in April 2020. CT angiography revealed 'de novo' occlusions of the left internal carotid artery and proximal right vertebral artery, effectively blocking anterior and posterior circulations. Delirium can lead to inaccurate stroke scale assessments and prolong initiation of COVID-19 stroke care pathways. Future studies are needed to look into the temporal relationship between confusion and neurological manifestations.

Acute confusional state as a prognostic sign of COVID-19 large-vessel occlusion (LVO)

Altmetrics

Test your medical knowledge with BMJ Case Report's quick educational modules.

   

BMJ Case Reports is a repository of evidence regarding health and its social determinants. Our case reports may be used for education and the improvement of clinical practice. The modules below offer opportunities to test your developing clinical skills.