Patient 5:
EMS brought a middle-aged man with unknown past medical history after
being found in a drowsy state by his neighbor. On physical exam, his
Glasgow Coma Scale (GCS) was 9/15. An urgent CT-head with angiography
showed a filling defect at the basilar artery’s bifurcation, causing
posterior circulation acute infarction with a surrounding penumbra. His
routine Chest X-ray showed increased bilateral Broncho-vascular
markings; however, he tested positive for the COVID-19 virus in nasal
swab PCR and had a normal sinus rhythm on ECG. We did not offer him
thrombolysis as the onset time is unknown, neither thrombectomy, as he
already had an established infarction on the plane CT-head. The MRI head
confirmed the previous C.T. findings and showed some areas of
hemorrhagic transformation. Later on, the patient developed further
deterioration in GCS, mandating intubation and mechanical ventilation.
6-days into his course, he developed refractory hypotension and
bradycardia followed by asystole and could not be revived with
cardiopulmonary resuscitation (CPR).