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.