Table 1. Clinical Characteristics of Five Young Patients Presenting with Large-Vessel Stroke.*.
| Variable | Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 |
|---|---|---|---|---|---|
| Age — yr | 33 | 37 | 39 | 44 | 49 |
| Sex | Female | Male | Male | Male | Male |
| Medical history and risk factors for stroke† | None | None | Hyperlipidemia, hypertension | Undiagnosed diabetes | Mild stroke, diabetes |
| Medications | None | None | None | None | Aspirin (81 mg), atorvastatin (80 mg) |
| NIHSS score‡ | |||||
| On admission | 19 | 13 | 16 | 23 | 13 |
| At 24 hr | 17 | 11 | 4 | 19 | 11 |
| At last follow-up | 13 (on day 14) |
5 (on day 10) |
NA; intubated and sedated, with multiorgan failure | 19 (on day 12) |
7 (on day 4) |
| Outcome status | Discharged to rehabilitation facility |
Discharged home | Intensive care unit | Stroke unit | Discharged to rehabilitation facility |
| Time to presentation — hr | 28 | 16 | 8 | 2 | 8 |
| Signs and symptoms of stroke | Hemiplegia on left side, facial droop, gaze preference, homonymous hemianopia, dysarthria, sensory deficit | Reduced level of consciousness, dysphasia, hemiplegia on right side, dysarthria, sensory deficit | Reduced level of consciousness, gaze preference to the right, left homonymous hemianopia, hemiplegia on left side, ataxia | Reduced level of consciousness, global dysphasia, hemiplegia on right side, gaze preference | Reduced level of consciousness, hemiplegia on left side, dysarthria, facial weakness |
| Vascular territory | Right internal carotid artery | Left middle cerebral artery | Right posterior cerebral artery | Left middle cerebral artery | Right middle cerebral artery |
| Imaging for diagnosis | CT, CTA, CTP, MRI | CT, CTA, MRI | CT, CTA, CTP, MRI | CT, CTA, MRI | CT, CTA, CTP |
| Treatment for stroke | Apixaban (5 mg twice daily) | Clot retrieval, apixaban (5 mg twice daily) | Clot retrieval, aspirin (81 mg daily) | Intravenous t-PA, clot retrieval, hemicraniectomy, aspirin (81 mg daily) | Clot retrieval, stent, aspirin (325 mg daily), clopidogrel (75 mg daily) |
| Covid-19 symptoms | Cough, headache, chills | No symptoms; recently exposed to family member with PCR-positive Covid-19 | None | Lethargy | Fever, cough, lethargy |
| White-cell count — per mm3 | 7800 | 9900 | 5500 | 9000 | 4900 |
| Platelet count — per mm3 | 427,000 | 299,000 | 135,000 | 372,000 | 255,000 |
| Prothrombin time — sec | 13.3 | 13.4 | 14.4 | 12.8 | 15.2 |
| Activated partial-thromboplastin time — sec | 25.0 | 42.7 | 27.7 | 26.9 | 37.0 |
| Fibrinogen — mg/dl | 501 | 370 | 739 | 443 | 531 |
| d-dimer — ng/ml | 460 | 52 | 2230 | 13,800 | 1750 |
| Ferritin — ng/ml | 7 | 136 | 1564 | 987 | 596 |
Reference ranges are as follows: platelet count, 150,000 to 450,000 per cubic millimeter; prothrombin time, 12.3 to 14.9 seconds; activated partial-thromboplastin time, 25.4 to 34.9 seconds; fibrinogen, 175 to 450 mg per deciliter; d-dimer, 0 to 500 ng per milliliter; and ferritin, 30 to 400 ng per milliliter. CT denotes computed tomography, CTA CT angiography, CTP CT perfusion, MRI magnetic resonance imaging, NA not applicable, PCR polymerase chain reaction, and t-PA tissue plasminogen activator.
The patients were screened for smoking, hypertension, hyperlipidemia, diabetes, atrial fibrillation, congestive heart failure, illicit drug use, and neck trauma.
Scores on the National Institutes of Health Stroke Scale (NIHSS) range from 0 to 42, with higher numbers indicating more severe stroke.