ABSTRACT
Multiple cerebral infarctions coexisting with peripheral artery occlusion have been rarely reported and occur only in specific conditions. Also, the characteristics of thrombosis related to the outbreak of the coronavirus disease 2019 (COVID-19) have been observed and studied recently. We report a case of concurrent multiple cerebral infarctions and peripheral embolism in a patient with a recent history of COVID-19 infection. A 62-year-old male patient who had recently been infected with COVID-19 presented to our emergency department with left hemiparesis. Supportive treatments were given post the diagnosis of multiple cerebral infarctions in the right cerebral hemisphere. During the supportive treatments, motor weakness was seen in the right upper extremity. Computed tomography revealed thrombi in the right axillary, brachiocephalic, and brachial arteries. The patient was already taking antiplatelet and anticoagulant agents and had no other underlying disease to develop such occlusions except his recent history of COVID-19 infection. We checked his laboratory tests for coagulation profiles throughout the hospitalization to verify a possible cause. We believe that large thrombi formation due to COVID-19 can simultaneously cause embolism in the cerebrum and peripheral regions. This pathology can result in symptoms that could make diagnosis difficult, delaying treatment decisions. This report, therefore, suggests that it is necessary to take into account a patient’s history of COVID-19 infection in such situations, especially when the patient presents with symptoms of a stroke.
ABSTRACT
This retrospective case-control study investigated the prevalence and risk factors of carbapenem-resistant Enterobacteriaceae (CRE) colonization in stroke patients within 6 months of onset. Forty-three patients confirmed to have CRE colonization in our hospital from January 2017 to December 2018 were included in this study. The control group included 44 stroke patients who had carbapenem-susceptible Enterobacteriaceae colonization. The patients were age- (± 3 years) and sex-matched. Their demographic and clinical characteristics were analyzed to identify the risk factors for CRE colonization using multivariate logistic regression analysis. During the study period, the prevalence of CRE was 2.9% (105/3,657). In the univariate analysis, factors associated with CRE colonization included the use and duration of antibiotic intake; admission to intensive care unit (ICU); and use of enteral feeding tube, urethral Foley catheter, tracheostomy, and central venous catheter. In the multivariate analysis, use and duration of antibiotic intake and admission to ICU persisted as independent factors. CRE should be considered when antibiotics are administered to a stroke patient, especially if the administration period is more than 2 weeks, and if the stroke patient has been admitted to the ICU. This study suggests preventing post-stroke infections and, if possible, reducing ICU admissions and preventing CRE transmission in all stroke patients admitted to the ICU.