Bilateral Large Vessel Occlusion Causing Massive Ischemic Stroke in a COVID-19 Patient

J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105609. doi: 10.1016/j.jstrokecerebrovasdis.2021.105609. Epub 2021 Jan 8.


The case of a 70-year-old male presenting an ischemic stroke related to COVID-19 infection is described. He was initially admitted to the hospital with respiratory insufficiency syndrome secondary to pneumonia caused by SARS Co2. In the next days, he developed rapid neurological deterioration characterized by drowsiness which progressed to deep coma. D-dimer was elevated. Brain CT scan showed bilateral massive ischemic stroke located in the anterior circulation, CT angiogram showed occlusion in the left internal carotid artery and the right middle cerebral artery. The deterioration of the patient continued and he subsequently died. Large vessel occlusion has been reported in COVID-19 patients, but this clinical presentation is usually unilateral. Cases of bilateral occlusion of large vessels have not been previously reported in COVID-19 patients. This report shows that bilateral massive stroke may occur in COVID-19 cases and it should be suspected in patients who show rapid neurological deterioration without focal deficits.

Keywords: Bilateral ischemic stroke; COVID-19 stroke; Large vessel occlusion; Massive stroke.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Arterial Occlusive Diseases / etiology*
  • Brain / diagnostic imaging
  • COVID-19 / complications*
  • COVID-19 / diagnostic imaging
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / etiology
  • Coma / etiology
  • Computed Tomography Angiography
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Infarction, Middle Cerebral Artery / diagnostic imaging
  • Infarction, Middle Cerebral Artery / etiology
  • Ischemic Stroke / diagnostic imaging
  • Ischemic Stroke / etiology*
  • Male
  • Nervous System Diseases / etiology
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy
  • Thrombectomy


  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D