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. 2021 Jul 29;10(15):3349. doi: 10.3390/jcm10153349

Table 1.

Case reports of acute cerebrovascular events related to COVID-19.

Region Age, Gender Neurological Symptoms on Admission (Day from Admission) Other Symptoms (Onset Day Prior Neurologic Symptoms or after Admission) Admission Serum Labs (or Day from Admission) Imaging or EEG (Day from Admission) Treatments Received Outcome Ref
Ischemic Stroke
Wuhan, China 79, M One-day right limb weakness, mild expressive aphasia (on exam) Cough (7 days prior) Lymphocytopenia, ↑ CRP (36.1 mg/L), ESR (43 mm/h), & lipoprotein(a) (1276 mg/L); normal cardiac, renal, &coagulation functions Head CT scan: lacunar cerebral infarction.
48-h Holter monitoring: paroxysmal AF.
Oseltamivir, ribavirin, moxifloxacin, dexamethasone, clopidogrel, atorvastatin Favorable; recovery within 12 days [65]
London, UK 64, M Mild left arm weakness, word-finding difficulty & incoordination (day 5); evolving to
bilateral incoordination & right homonymous hemianopia (day 12)
Cough, dyspnea, fever, myalgia & poor appetite (10 days prior); evolving to respiratory failure (admission day) & PE (day 9) ↓ Hgb (119 g/L); ↑ LDH (654 U/L), ALT (137 U/L), PT (12.5 s), fibrinogen (950 mg/dL), D-dimer (>80,000 µg/L), ferritin (4927 µg/L) & CRP (305.4 mg/L); lupus anticoagulant (+); normal CBCdiff, aPTT & INR. Brain MRI (day 5): acute left vertebral artery thrombus and acute left PICA territory infarction with petechial hemorrhagic transformation.
DWI MRI (day 12): bilateral acute PCA territory infarcts despite therapeutic anticoagulation.
Lower limb Doppler ultrasound: occlusive DVT in left posterior tibial & peroneal veins.
CT pulmonary angiogram (day 9): bilateral PE.
Initially aspirin & clopidogrel; then high-intensity LMWH anticoagulation (for PE) Poor; ICU admission [13]
London, UK 53, F Acute confusion, incoordination, impaired consciousness (GCS 13/15) Malaise, cough, fever & dyspnea (24 days prior) ↓ Hgb (94 g/L); leukocytosis (WBC 23K), ↑ LDH (664 U/L), PT (34.4 s), INR (3.6), aPTT (41 s), D-dimer (7750 µg/L), ferritin (1853 µg/L) & CRP (150.1 mg/L); lupus anticoagulant (+); Normal fibrinogen & LFT. Head CT Scan: acute right parietal cortical & left cerebellar infarct with mass effect & hydrocephalus, despite therapeutic anticoagulation. EVD for hydrocephalus & therapeutic LMWH anticoagulation Death due to COVID-19 related cardiorespiratory failure [13]
London, UK 85, M Dysarthria, right facial droop, right-sided hemiparesis Cough (10 days prior) ↓ Hgb (128 g/L); ↑ LDH (461 U/L), D-dimer (16,100 µg/L), fibrinogen (530 mg/dL), ferritin (1027 µg/L) & CRP (161.2 mg/L); lupus anticoagulant (−); normal CBCdiff, PT, aPTT, INR & LFT. Head CT Scan: hyperdensity consistent with thrombus in the left PCA & acute infarction in left temporal stem and cerebral peduncle. Apixaban for AF NR [13]
London, UK 61, M Acute dysarthria & left facial droop & hemiparesis (2 days prior COVID-19 symptoms started) Fever, cough, dyspnea & tachypnea (2 days after admission) ↓ Hgb (126 g/L) & aPTT (24 s); thrombocytosis (408 K), ↑ LDH (444 U/L), fibrinogen (463 mg/dL), D-dimer (27,190 µg/L) & ferritin (1167 µg/L); lupus anticoagulant (+); normal CRP, PT, INR & LFT. DWI brain MRI: acute infarction in the right corpus striatum suggesting transient occlusion of the M1 segment of the right MCA; FLAIR MRI: an established infarct in the same region with moderate background cerebral small vessel disease.
CT pulmonary angiogram: pulmonary embolus in the left upper lobe segmental artery.
Therapeutic LMWH anticoagulation NR [13]
London, UK 83, M Acute dysarthria, left facial droop & hemiparesis, & left-sided sensory inattention Fever, cough, dyspnea & fatigue (15 days prior) ↓ Hgb (121 g/L); leukocytosis (WBC 11K), ↑ LDH (353 U/L), fibrinogen (496 mg/dL), D-dimer (19,450 µg/L) & CRP (27.7 mg/L); lupus anticoagulant (+); normal PT, aPTT, INR & LFT. Head CT/CT angiogram: thrombotic occlusion of a proximal M2 branch of the right MCA;
Repeat CT (24 h): a focus of parenchymal low density involving the right insular cortex in keeping with an evolving right MCA territory infarct
Intravenous thrombolysis NR [13]
London, UK 73, M Acute aphasia & right facial droop & hemiparesis Dyspnea & tachypnea (8 days prior) Thrombocytosis (403 K), ↑ LDH (439 U/L), PT (12.3 s), D-dimer (1080 µg/L), ferritin (655 µg/L) & CRP (179.9 mg/L); lupus anticoagulant (+); normal PT, aPTT, INR & LFT. DWI brain MRI: acute infarction in the right thalamus, left pons, right occipital lobe and right cerebellar hemisphere.
Time-of-flight images: thrombotic material in the basilar artery and bilateral mild-to-moderate P2 segment stenosis.
Intravenous thrombolysis, decreasing D-dimer (1080 μg/L). NR [13]
New York, USA 33, F 28-h left hemiplegia, facial droop, gaze preference, homonymous hemianopia, dysarthria, sensory deficit, admission NIHSS 19 Cough, headache & chills (7 days prior) ↑ fibrinogen (501 mg/dL); normal WBC, platelets, PT, aPTT, D-dimer & ferritin. Head CT/CT angiogram/MRI: partial infarction of the right MCA with a partially occlusive thrombus in the right carotid artery at the cervical bifurcation. Apixaban (5 mg twice daily) Favorable; complete resolution of thrombus in repeat CT angiogram (day 10), follow up NIHSS 13 (day 14) [64]
New York, USA 37, M 16-h impaired consciousness, dysphasia, right hemiplegia, dysarthria, sensory deficit, admission NIHSS 13 No symptoms;
exposed to family member
with PCR-positive
COVID-19
⭡ aPTT (42.7 s); normal WBC, platelets, PT, INR, fibrinogen, D-dimer & ferritin. Head CT/CT angiogram/MRI: left MCA territory ischemic infarction Clot retrieval, apixaban (5 mg twice daily) Favorable; follow up NIHSS 5 (day 10) [64]
New York, USA 39, M 8-h impaired consciousness, gaze preference to the right, left homonymous hemianopia, left hemiplegia, ataxia, admission NIHSS 16 No symptoms ↑ fibrinogen (739 mg/dL), D-dimer (2230 µg/L) & ferritin (1564 µg/L); normal CBCdiff, PT & aPTT. Head CT/CT angiogram/MRI: right PCA territory ischemic infarction Clot retrieval, aspirin (81 mg/day) Poor; multiple organ failure & intubated/sedated in ICU [64]
New York, USA 44, M 2-h impaired consciousness, global dysphasia, right hemiplegia, gaze preference, admission NIHSS 23 Lethargy ↑ D-dimer (13,800 µg/L) & ferritin (987 µg/L); normal CBCdiff, LFT, RFT, PT, aPTT & fibrinogen. Head CT/CT angiogram/MRI: left MCA territory ischemic infarction IV t-PA, clot retrieval,
hemicraniectomy, & aspirin (81
mg/day)
NR; stay in stroke unit, follow up NIHSS 19 (day 12) [64]
New York, USA 49, M 8-h impaired consciousness, left hemiplegia, dysarthria, facial weakness, admission NIHSS 13 Fever, cough & lethargy ↑ PT (15.2 s), aPTT (37 s), fibrinogen (531 mg/dL), D-dimer (1750 µg/L) & ferritin (596 µg/L); normal CBCdiff, LFT & RFT. Head CT/CT angiogram/MRI: right MCA territory ischemic infarction Clot retrieval & stent, aspirin (325 mg/day), & clopidogrel (75 mg/day) Favorable; follow up NIHSS 7 (day 4) [64]
New York, USA 73, M Acute altered mental status with hypoxemic respiratory failure (intubation) Fever & dyspepsia (admission); nausea, vomiting & poor appetite (2 days prior) ⭡ CRP (26 mg/dL), prolonged PT (13.5 s), normal aPTT, LFT, & RFT; D-dimer, CRP & ferritin not checked. Head CT scan: loss of gray-white differentiation at the left occipital & parietal lobes, consistent with acute infarction.
Repeat CT head: progression toward a large acute infarct of the left MCA territory with hyperdense appearance of left MCA vessels - consistent with an acute thrombus.
Aspirin & supportive care Poor; comfort measures only & terminally extubation [66]
New York, USA 83, F Admission: acute left facial droop, slurred speech, admission NIHSS 2.
Day 3: left hemineglect, worsening left facial droop, & left hemiparesis, NIHSS 16
Fever & poor oral intake (admission) Leukopenia & lymphocytopenia; D-dimer not checked. Head CT/ CT angiogram (admission): No acute change, focal moderate stenosis of right MCA.
Head CT (day 3): new moderate hypodensity in the right frontal lobe representing acute infarction.
Integrellin not started due to respiratory failure Poor; respiratory failure & withdrawal of care [66]
New York, USA 80, F Acute altered mental status, aphasia & left side weakness, admission NIHSS 36 No symptoms; frequent falls (for 7 days) Leukocytosis, lymphocytopenia,
⭡ D-dimer (13,966 µg/L), LDH (712 U/L) & CRP (16.24 mg/dL); prolonged PT (15.2 s); normal procalcitonin, aPTT, LFT & RFT.
Head CT scan: an acute right MCA stroke.
Head/neck CTA: occlusion of the right internal carotid artery at origin.
CT perfusion: a 305-cc core infarct in the right MCA distribution and a surrounding 109 cc ischemic penumbra.
Supportive care Poor, comfort measures only and terminally extubation [66]
New York, USA 88, F Transient 15-min right arm weakness & numbness, & word-finding difficulty Mild dyspnea & cough (admission) ⭡ D-dimer (3442 µg/L), CRP (12.7 mg/L) & IL-6 (8.5 pg/mL); prolonged PT (13.5 s); normal ferritin, procalcitonin, aPTT, Hgb, CBCdiff, LDH, LFT & RFT. Head CT scan: normal.
Brain MRI: acute infarct in the left medial temporal lobe.
Head/neck MR angiogram: mild stenosis of the right M1 segment
Aspirin & statins Favorable [66]
New York, USA 52, M Acute global aphasia, right hemiparesis & left gaze preference, admission NIHSS 20 Fever, cough & dyspnea (7 days prior) ⭡ D-dimer (>10,000 µg/L), fibrinogen (235 mg/dL), ferritin (588 µg/L), CRP (11 mg/L) & ESR (37 mm/h). Head CT scan: hyperdensity
of the M1 segment of the left MCA.
Head/neck CT angiogram: a left intracranial internal carotid artery occlusion.
Repeat CT head: early infarct signs of in the left basal ganglia, internal capsule, caudate head, insular ribbon, operculum, & right posterior frontal lobe.
CT perfusion: a favorable mismatch ratio
of 4.1
IV alteplase, clot retrieval, aspirin, statin, & hydroxychloroquine Partial recovery upon discharge [67]
New Jersey, USA 84, M Respiratory distress & unequal pupils Fever, dyspnea, cough, & abdominal pain (14 days prior) Lymphocytopenia, ↑ D-dimer (21,600 µg/L) & procalcitonin (0.25 ng/mL). Head/neck CT/CTA: distal basilar artery occlusion extending into the proximal PCA, small aortic arch thrombus.
Chest CT: bilateral lobar pulmonary emboli
LMWH (for PE); Clot retrieval Death (Day 1) [68]
Detroit, USA 72, F Impaired consciousness, GCS 3 (day 10) Progressive cough, myalgia, & dyspnea (21 days prior) Admission: leukocytosis, acute kidney injury, transaminitis, & rhabdomyolysis; ↑ CRP & ferritin.
Day 7: ↑ aPTT (28.5 s), PT (13.5 s), INR (1.32), mild thrombocytopenia (146K),
Head CT scan (day 10): bilateral cerebral infarcts in multiple vascular territories including cortical & subcortical regions. Palliative care Death [69]
Philadelphia, USA 62, F First admission: acute aphasia & right hemiparesis.2nd admission (10 days after): altered mental status No symptoms Negative COVID-19 rRT-PCR in CSF (two times in 2nd admission). Head CT angiogram (first admission): left MCA occlusion.
Head CT scan (2nd admission): hemorrhagic conversion with midline shift & obstructive hydrocephalus
Clot retrieval (first admission), decompressive hemicraniectomy & EVD (2nd admission) Poor; stay in ICU [14]
Los Angeles, USA 70s, Acute aphasia, right hemiparesis & facial droop (day 5) acute chest pain, diaphoresis, & hypotension with ST-elevation myocardial infarction (admission) ↑ aPTT (>85.5) while on heparin, renal failure, normal platelet count Brain MRI: 60-cc acute infarct in the left insular, temporal, parietal, and frontal lobes, as well as smaller acute infarcts in the right caudate & left cerebellar hemisphere.
MR angiogram: left MCA proximal M1 segment occlusion.
Palliative care Poor [70]
Toulouse, France 73, M 9-h acute aphasia & right hemiparesis, admission NIHSS 10 Fever & cough (7 days prior) Lymphocytopenia, ⭡ CRP (219 mg/L), ferritin (109.6 µ/dL), fibrinogen (820 mg/dL) & D-dimer (2220 µg/L); normal platelets; negative antiphospholipid antibodies. Head CT/CT angiogram/perfusion/MRI: subtle cortical left frontal hypoattenuation with more extended surrounding hypoperfusion & distal occlusion of left MCA branch; a large intraluminal floating thrombus appended to a hypoattenuated non-stenosing plaque of the left common carotid artery wall. LMWH anticoagulation (enoxaparin) Favorable; resolution of thrombus on carotid ultrasound (15 days after onset); follow up NIHSS 3 (day 10, discharge day) [71]
Ronse, Belgium 74, F Continued unconsciousness after extubation on day 16 & a mild endorotation of the arms Fever, dyspnea & cough (7 days prior); evolving to hypoxic respiratory failure & intubation (admission day 3) Slight lymphocytopenia, ⭡ CRP (18.79 mg/L), procalcitonin (1.93 ng/mL), ferritin (846.1 μg/L) & mild ⭡ creatinine (1.02 mg/dL); Day 2: ⭡ D-dimer (2504 µg/L).
Day 16: ⭡ D-dimer (3941 µg/L) & fibrinogen (606 mg/dL); normal PT & platelets.
Head CT scan: large left MCA ischemic infarction with additional edema and midline shift; hyperdense artery sign was seen due to a thrombotic occlusion at the transition of the left internal carotid artery to the origin of the MCA. Palliative care Death (day 16) [72]
Bilbao, Spain 36, F 48-h aphasia & acute right hemiplegia, admission NIHSS 21 No symptoms Leukocytosis (23.6K), ⭡ CK (8669 U/L) & D-dimer (7540 µg/L) & CRP (15.6 mg/L). Head CT scan: established infarct in the left MCA territory with a mild deviation of the midline.
Head/neck CT angiogram: occlusion of the left internal carotid artery, MCA & ACA with a free-floating thrombus in the ascending aorta with no signs of aortic atheromatosis.
CT pulmonary angiogram: bilateral PE.
Palliative care Death within 72 h [73]
Intracranial hemorrhage
Philadelphia, USA 31, M Acute headache & loss of consciousness Malaise, fever, cough & arthralgia (7 days prior) Negative COVID-19 rRT-PCR in CSF. Head CT scan: SAH centered in the posterior fossa, including the 4th ventricle with hydrocephalus.
Head CT angiogram: right-sided ruptured dissecting PICA aneurysm.
EVD for hydrocephalus & flow-diverting stent for aneurysm Favorable; gradual improvement in mental status [14]
Düsseldorf, Germany 60, F Loss of consciousness Concurrent respiratory insufficiency requiring intubation Leukocytosis (14.2K), ⭡ troponin (45 ng/mL), CK (4920 U/L), CRP (11 mg/L), LDH (360 U/L) & GGT (103 U/L); normal CSF study. Head CT/CT angiogram: left frontal haemorrhage with ventricle bleeding from a ruptured pericallosal artery aneurysm (~5 mm).
CT perfusion (day 3, 6, 9 & 12): no cerebral vasospasm.
Aneurysm clipping & pneumonia treatment Favorable [74]
Brescia, Italy 57, M Bilaterally fixed & dilated pupils, GCS 3 (day 11) Fever & cough (7 days prior), worsening dyspnea (3 days prior) Day 4: ↑ CRP, LDH, AST, & GGT.Day 11: prolonged aPTT (53.1 s), ↑ D-dimer (2866 µg/L). Head CT scan (day 11): bilateral cerebellar hemispheric hemorrhage with 4th ventricle & brainstem compression and supratentorial hydrocephalus & diffuse obliteration of sulci.
CT angiogram: Normal.
NR Death (1 h after CT) [43]
Brescia, Italy 57, M bilaterally fixed and dilated pupils, GCS 3 (day 12) Fever & cough (10 days prior), dyspnea (3 days prior) Admission: ↑ CRP (21 mg/L), LDH (771 U/L), AST (100 U/L), GGT (152 U/L). Head CT scan: diffuse cerebral edema with a large right frontal hemorrhage extending to ventricles. LMWH (for PE) prior neurological deterioration Death (shortly after CT) [43]
Sari, Iran 79, M Acute loss of consciousness Fever & cough (3 days prior) Lymphocytopenia, thrombocytosis (210 K); prolonged PT (12 s), INR (1), & aPTT (64 s); ↑ ESR (85 mm/h), CRP (10 mg/L), & creatinine (1.4 mg/dL); normal LFT Head CT scan: massive right-hemispheric hemorrhage extending to ventricles & SAH NR NR [75]
Cerebral venous thrombosis
Wales, UK 59, M First admission: 4-day progressive headache
Second admission (4 days later): acute right sided weakness & numbness, slurred speech, expressive aphasia, admission NIHSS 10
First admission: fever & hypertension. Prolonged aPTT (22.3 s), ⭡ CRP (15 mg/L) & creatinine (57 mg/dL); normal CBCdiff, PT & fibrinogen. Head CT scan (1st admission): hyperdensity within the superior sagittal sinus, right transverse sinus, sigmoid sinus & upper right internal jugular vein suggestive of venous thrombosis.
Head CT venogram (1st admission): normal; however, it was re-reviewed 4 days later (2nd admission): filling defect in the right sigmoid & transverse sinus involving the torcula.
LMWH Favorable; NIHSS 4 within 24 h [32]
New York, USA 38, M Seven-day headache & 2-day impaired consciousness; evolving to extensor posturing of the arms & clonus with NIHSS 14 Persistent diarrhea & vomiting (10 days prior) NR Head CT scan: Hyperdensity in the straight sinus, distal superior sagittal sinus, torcular & right transverse sinus, & in several cortical veins adjacent to the superior sagittal sinus, suggestive of cerebral venous thrombosis.Head CT venogram: near-occlusive thrombus in the right internal cerebral vein. Enoxaparin (70 mg subcutaneously twice a day) & clot retrieval, lopinavir, ritonavir Death within 32 h [76]
New York, USA 41, F Acute confusion, global aphasia & left gaze preference, admission NIHSS 16; rapidly worsening mental status & extensor posturing to noxious stimulation requiring intubation Prior admission for COVID-19 ⭡ D-dimer (2032 µg/L).
CSF: ⭡ protein (616 mg/dL) & 41 WBC (PMN 84%), normal glucose.
Head CT/CT angiogram (admission): normal.
Repeat CT head: a venous infarction in the left basal ganglia, thalamus, & mesial temporal lobe with hemorrhagic transformation, intraventricular hemorrhage, & obstructive hydrocephalus.
Head CT venogram: occlusion of the internal cerebral veins.
EVD & heparin infusion Death within 4 days [76]
New York, USA 32, M One-week headache & impaired consciousness Concurrent 7-day fever & dry cough ↑ Glucose (1384 mg/dL), D-dimer (>11000 µg/L) & ferritin (18,431 µg/L) Head CT scan: patchy areas of low density in the bilateral cerebral hemispheres with foci of subcortical hemorrhage in the left parieto-occipital region.
Head CT angiogram: normal.
Brain MRI: confluent, nonenhancing regions of pathologically reduced diffusion throughout the subcortical & deep hemispheric white matter bilaterally, left greater than right. Punctate foci of susceptibility artifacts consistent with petechial hemorrhage on gradient recalled-echo images, suspecting diabetic ketoacidosis related venous thrombosis.
Azithromycin, hydroxychloroquine Death within few days [76]
Rome, Italy 44, F Ingravescent dyspnea, headache, impaired consciousness, aphasia & right hemiparesis Fever, cough & dyspnea (14 days prior) Neutrophilic leukocytosis, lymphocytopenia, thrombocytopenia (42 K); ↑ D-dimer (5975 µg/L), CK-MB (6.9 µg/L),; Negative anti-cardiolipin, -β2-glycoprotein & -dsDNA antibodies Head CT angiogram: Dural sinus thrombosis with poor representation of left internal cerebral vein.
Pulmonary CT angiogram: Filling defect within the inferior trunk of the right pulmonary artery and along the superior vena cava by thrombi.
NR NR [77]
Paris, France 62, F Headache & altered vision, evolving to sudden right hemicorporeal deficit & impaired consciousness Fever, cough &dyspnea (15 days prior) Leukocytosis (20 K); ↑ AST (54 U/L), ALT (68 U/L), GGT (87 U/L), & D-dimer (14,200 µg/L) Head CT scan & brain MRI: large confluent intraparenchymal hemorrhage in the
left fronto-temporal lobes.
CT venogram: cerebral venous thrombosis of the left transverse sinus, straight vein, vein of Galen and internal cerebral veins.
NR NR [16]
Paris, France 54, F Severe headache Fever & asthenia (14 days prior) Leukocytosis (18K), ↑ CRP (170.8 mg/L) & D-dimer (2360 µg/L) Head CT scan & brain MRI: large hemorrhagic infarction in the left temporal
lobe.
CT venogram and MR angiography: cerebral venous thrombosis of the left transverse sinus
NR NR [16]
Madrid, Spain 13, F Impaired consciousness & intense headache Fever, cough, & odynophagia (7 days prior) followed by frontal headache & vomiting Leukocytosis (14.4 K), lymphocytopenia, thrombocytopenia; ↑ D-dimer (33,960 µg/L), CRP (12.55 mg/dL), LDH (322 U/L), & ferritin (240 ng/mL); fibrinogen (0 mg/dL). Head CT scan: right occipital intracerebral hemorrhage. MR angiogram: bilateral transverse sinus thrombosis extending to right sigmoid sinus & internal jugular vein.Body angio-CT scan (day 3): thrombosis
progression towards the posterior half of superior sagittal sinus, bilateral PE & bilateral deep femoral and iliac veins thrombosis reaching infrarenal cava.
IV fluid, empiric antibiotics, hypertonic saline, Fibrinogen, platelet & plasma transfusion; later lopinavir, ritonavir, hydroxychloroquine, & azithromycin; LMWH Favorable; recovery within 24 days [78]

↑, increased; ↓, decreased; AF, atrial fibrillation; aPTT, activated partial thromboplastin time; ACA, anterior cerebral artery; ALT, alanine aminotransferase; ARDS, acute respiratory distress syndrome; AST, aspartate aminotransferase; CBCdif, complete blood counts with differential; CK, creatine kinase; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; CSF, cerebrospinal fluid; DWI, diffusion-weighted imaging; ESR, erythrocyte sedimentation rate; EVD, external ventricular drainage; F, female; GGT, gamma glutamyl transferase; Hgb, hemoglobulin; ICA, internal carotid artery; IL, interleukin; INR, international normalized ratio; LAC, lupus anticoagulant; LDH, lactate dehydrogenase; LFT, liver function test; LMWH, low molecular weight heparin; M, male; MCA, middle cerebral artery; NIHSS, National Institutes of Health Stroke Scale; NR, not reported; PCA, posterior cerebral artery; PE, pulmonary embolism; PICA, posterior–inferior cerebellar artery; PMN, polymorphonuclear; PT, prothrombin time; RFT, renal function test; SAH, subarachnoid hemorrhage; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; t-PA, tissue plasminogen activator; WBC, white blood cell; WFD, word finding difficulty.