Oropharyngeal swab for SARS-CoV-2 test causing atypical internal carotid artery dissection and stroke in a patient after mild COVID-19

Livia Asan; Cornelius Deuschl; Michael Forsting; Christoph Kleinschnitz; Martin Köhrmann

doi:10.1177/17562864211033521

Oropharyngeal swab for SARS-CoV-2 test causing atypical internal carotid artery dissection and stroke in a patient after mild COVID-19

Ther Adv Neurol Disord. 2021 Jul 23:14:17562864211033521. doi: 10.1177/17562864211033521. eCollection 2021.

Authors

Livia Asan¹, Cornelius Deuschl², Michael Forsting², Christoph Kleinschnitz³, Martin Köhrmann³

Affiliations

¹ Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, Essen, 45147, Germany.
² Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
³ Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany.

Abstract

We report a patient who had recovered from pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presenting with acute cerebral ischemia due to atypical dissection of the left internal carotid artery immediately after an oropharyngeal swab (OPS) for SARS-CoV-2 RT-PCR testing. The symptoms consisting of right-side hemiparesis and aphasia improved after systemic thrombolysis and the patient recovered completely in the further course. We demonstrate findings from imaging (computed tomography, magnetic resonance imaging, neurovascular ultrasound) among other investigations and discuss coronavirus disease 2019 (COVID-19)-related vessel wall vulnerability as well as tissue injury posed by the swab procedure as underlying causes of the dissection. Individuals performing OPSs during the corona pandemic should be aware of this so far undescribed complication.

Keywords: COVID-19; SARS-CoV-2; cervical artery dissection; stroke; swab.

Publication types

Case Reports