Massive Arterial Cerebral Thrombosis in a 59-year old Female Patient With Severe COVID-19

Hypercoagulable states characterized by micro- and macro-vascular thrombotic angiopathy have been observed in COVID-19 patients. Although venous thrombotic events have been well described, data on arterial thrombosis (AT) is still insubstantial. We present a case of COVID-19 complicated with massive arterial cerebral thrombosis. Our case is a 59-year old female with history of hypertension who presented to the outpatient clinic in East Jeddah Hospital, Saudi Arabia, with sore throat, cough and arthralgia for two days. She was confirmed to be COVID-19 positive and started on azithromycin and supportive home care. Her condition worsened and she presented nine days later with drowsiness and generalized weakness. At the hospital, she was diagnosed with severe COVID-19 and was started on prophylaxis enoxaparin. She showed progressive worsening of mental function. Her CT brain showed diffuse extensive arterial cerebral thrombosis. She remained unresponsive and showed an abnormal breathing pattern on mechanical ventilation. She died on day 4 after admission.