Patient 2:
A 60-year-old man diabetic and hypertensive with right nephrectomy for
angiomyolipoma. We hospitalized him after testing positive for COVID-19
PCR from a nasopharyngeal swab. Initially, he was complaining of fever,
cough, but he had no signs of respiratory distress. We started him on
hydroxychloroquine, azithromycin, ritonavir/lopinavir, and
methylprednisolone in addition to anticoagulation for mild COVID-19
pneumonia in a high-risk patient. On Day 12 of the disease course, the
patient experienced an insidious onset of left-sided upper limb weakness
with slurring in speech. Physical examination revealed left-side body
weakness with left upper facial nerve palsy and dysarthria. His initial
NIHSS was 22; however, shortly afterward, he started to become confused
with a progressive deterioration in his conscious level mandating
intubation and mechanical ventilation. An urgent CT-head with
CT-perfusion confirmed a large rea of matched perfusion defect involving
the whole right MCA territory, with no clear salvageable tissue. A CT
Angiogram revealed a completely occluded right MCA. We deferred
thrombolysis because of a significant risk of ICH development secondary
to the large area of infarction. Hence, there are matched MCA territory
changes, and there are no collaterals; with an ASPECT score of 3,
thrombectomy was not feasible either.