TY - JOUR T1 - Acute confusional state as a prognostic sign of COVID-19 large-vessel occlusion (LVO) JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2020-240536 VL - 14 IS - 2 SP - e240536 AU - Smit Sunil Deliwala AU - Murtaza Hussain AU - Anoosha Ponnapalli AU - Dominic Awuah AU - Thair Dawood AU - Ghassan Bachuwa Y1 - 2021/02/01 UR - http://casereports.bmj.com/content/14/2/e240536.abstract N2 - 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. ER -