Patient 1:
An 80-year-old man with a past medical history of diabetes mellitus type
2 (Type 2 D.M.), hypertension, and prostate cancer on hormonal therapy,
presented to the E.D. complaining of fever, generalized fatigue, cough,
and shortness of breath for three days. Upon initial evaluation, he was
in respiratory distress with oxygen saturation of 92% on a
non-rebreather bag-mask (NRBM). His laboratory investigations were
significant for lymphopenia and elevated D-Dimer, C-reactive protein,
and ferritin levels. A chest x-ray showed bilateral perihilar
infiltrates. His real-time polymerase chain reaction (PCR) from
nasopharyngeal swab was positive for COVID-19; therefore, we started him
was on azithromycin, hydroxychloroquine, ritonavir/lopinavir combination
daily, steroids, and anticoagulation. He received tocilizumab for the
significant underlying inflammatory process; then, he reported a new
left-sided body weakness and tingling 24-hours after hospitalization.
His physical exam revealed reduced power in the right upper and lower
limbs with increased muscle tone. An urgent C.T. scan of the head ruled
out acute intracerebral bleeding. MRI and MRA of the head of T2/FLAIR
confirmed hyperintense acute infarct in the right parietal-frontal lobes[Figure1] , and smaller multifocal areas of patchy acute
infarcts in the left frontoparietal lobe, right more than left insula,
bilateral temporooccipital regions, left caudate head, and tiny acute
lacunar infarct in the right cerebellar hemisphere in addition to the
occluded right middle cerebral artery (MCA) from the origin in the neck