A Case of Isolated Dysarthria in a COVID-19 Infected Stroke Patient: A Nondisabling Neurological Symptom With Grave Prognosis.
Identifieur interne : 001A38 ( Main/Exploration ); précédent : 001A37; suivant : 001A39A Case of Isolated Dysarthria in a COVID-19 Infected Stroke Patient: A Nondisabling Neurological Symptom With Grave Prognosis.
Auteurs : Riwaj Bhagat [États-Unis] ; Siddharth Narayanan [États-Unis] ; Bibodh J. Karki [États-Unis] ; Wei Liu [États-Unis] ; Kerri Remmel [États-Unis]Source :
- Cureus [ 2168-8184 ] ; 2020.
Abstract
Isolated dysarthria is a speech abnormality characterized by slurring without any language dysfunction, or other neurological deficits. In an acute setting, it is commonly associated with stroke. In the context of social distancing during the current corona virus disease 2019 (COVID-19) pandemic, nondisabling symptoms such as isolated dysarthria can delay a patient's perception to seek immediate medical care. We present a rare case of isolated dysarthria in a COVID-19 infected stroke patient with a grave prognosis. A 79-year-old African American male presented with isolated dysarthria that manifested two days prior to his hospital visit. The dysarthria assessment showed impaired articulation, phonation, and prosody. Other neurological examinations were normal. He tested positive for the COVID-19 infection. His pulmonary CT scan showed bilateral ground glass opacities. An electrocardiogram showed atrial fibrillation (AF). Brain MRI revealed a punctate acute infarction in the left frontal lobe. Initially, he was treated with IV anticoagulation, oral beta-blocker, azithromycin and hydroxychloroquine, but he dramatically deteriorated within a week exhibiting a highly elevated cytokine level eventually resulting in multi-system organ failure. Despite aggressive treatment with steroids, tocilizumab and other supportive measures, the patient died of cardiac arrest. Our case highlights that acute stroke could manifest as an isolated dysarthria, which is an indicator of increased severity and high mortality with COVID-19 infection. Public awareness about the stroke symptom awareness should be emphasized.
DOI: 10.7759/cureus.9921
PubMed: 32968582
PubMed Central: PMC7505622
Affiliations:
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Karki</name><affiliation wicri:level="1"><nlm:affiliation>Infectious Disease, University of Louisville, Louisville, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Infectious Disease, University of Louisville, Louisville</wicri:regionArea><wicri:noRegion>Louisville</wicri:noRegion></affiliation></author><author><name sortKey="Liu, Wei" sort="Liu, Wei" uniqKey="Liu W" first="Wei" last="Liu">Wei Liu</name><affiliation wicri:level="1"><nlm:affiliation>Neurology, University of Louisville, Louisville, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Neurology, University of Louisville, Louisville</wicri:regionArea><wicri:noRegion>Louisville</wicri:noRegion></affiliation></author><author><name sortKey="Remmel, Kerri" sort="Remmel, Kerri" uniqKey="Remmel K" first="Kerri" last="Remmel">Kerri Remmel</name><affiliation wicri:level="1"><nlm:affiliation>Neurology, University of Louisville, Louisville, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Neurology, University of Louisville, Louisville</wicri:regionArea><wicri:noRegion>Louisville</wicri:noRegion></affiliation></author></analytic><series><title level="j">Cureus</title><idno type="ISSN">2168-8184</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Isolated dysarthria is a speech abnormality characterized by slurring without any language dysfunction, or other neurological deficits. In an acute setting, it is commonly associated with stroke. In the context of social distancing during the current corona virus disease 2019 (COVID-19) pandemic, nondisabling symptoms such as isolated dysarthria can delay a patient's perception to seek immediate medical care. We present a rare case of isolated dysarthria in a COVID-19 infected stroke patient with a grave prognosis. A 79-year-old African American male presented with isolated dysarthria that manifested two days prior to his hospital visit. The dysarthria assessment showed impaired articulation, phonation, and prosody. Other neurological examinations were normal. He tested positive for the COVID-19 infection. His pulmonary CT scan showed bilateral ground glass opacities. An electrocardiogram showed atrial fibrillation (AF). Brain MRI revealed a punctate acute infarction in the left frontal lobe. Initially, he was treated with IV anticoagulation, oral beta-blocker, azithromycin and hydroxychloroquine, but he dramatically deteriorated within a week exhibiting a highly elevated cytokine level eventually resulting in multi-system organ failure. Despite aggressive treatment with steroids, tocilizumab and other supportive measures, the patient died of cardiac arrest. Our case highlights that acute stroke could manifest as an isolated dysarthria, which is an indicator of increased severity and high mortality with COVID-19 infection. Public awareness about the stroke symptom awareness should be emphasized.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">32968582</PMID><DateRevised><Year>2020</Year><Month>09</Month><Day>28</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Print">2168-8184</ISSN><JournalIssue CitedMedium="Print"><Volume>12</Volume><Issue>8</Issue><PubDate><Year>2020</Year><Month>Aug</Month><Day>21</Day></PubDate></JournalIssue><Title>Cureus</Title><ISOAbbreviation>Cureus</ISOAbbreviation></Journal><ArticleTitle>A Case of Isolated Dysarthria in a COVID-19 Infected Stroke Patient: A Nondisabling Neurological Symptom With Grave Prognosis.</ArticleTitle><Pagination><MedlinePgn>e9921</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.7759/cureus.9921</ELocationID><Abstract><AbstractText>Isolated dysarthria is a speech abnormality characterized by slurring without any language dysfunction, or other neurological deficits. In an acute setting, it is commonly associated with stroke. In the context of social distancing during the current corona virus disease 2019 (COVID-19) pandemic, nondisabling symptoms such as isolated dysarthria can delay a patient's perception to seek immediate medical care. We present a rare case of isolated dysarthria in a COVID-19 infected stroke patient with a grave prognosis. A 79-year-old African American male presented with isolated dysarthria that manifested two days prior to his hospital visit. The dysarthria assessment showed impaired articulation, phonation, and prosody. Other neurological examinations were normal. He tested positive for the COVID-19 infection. His pulmonary CT scan showed bilateral ground glass opacities. An electrocardiogram showed atrial fibrillation (AF). Brain MRI revealed a punctate acute infarction in the left frontal lobe. Initially, he was treated with IV anticoagulation, oral beta-blocker, azithromycin and hydroxychloroquine, but he dramatically deteriorated within a week exhibiting a highly elevated cytokine level eventually resulting in multi-system organ failure. Despite aggressive treatment with steroids, tocilizumab and other supportive measures, the patient died of cardiac arrest. Our case highlights that acute stroke could manifest as an isolated dysarthria, which is an indicator of increased severity and high mortality with COVID-19 infection. Public awareness about the stroke symptom awareness should be emphasized.</AbstractText><CopyrightInformation>Copyright © 2020, Bhagat et al.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Bhagat</LastName><ForeName>Riwaj</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Neurology, University of Louisville, Louisville, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Narayanan</LastName><ForeName>Siddharth</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Surgery, University of Louisville, Louisville, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Karki</LastName><ForeName>Bibodh J</ForeName><Initials>BJ</Initials><AffiliationInfo><Affiliation>Infectious Disease, University of Louisville, Louisville, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Liu</LastName><ForeName>Wei</ForeName><Initials>W</Initials><AffiliationInfo><Affiliation>Neurology, University of Louisville, Louisville, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Remmel</LastName><ForeName>Kerri</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Neurology, University of Louisville, Louisville, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>08</Month><Day>21</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Cureus</MedlineTA><NlmUniqueID>101596737</NlmUniqueID><ISSNLinking>2168-8184</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">atrial fibrillation</Keyword><Keyword MajorTopicYN="N">covid-19</Keyword><Keyword MajorTopicYN="N">dysarthria</Keyword><Keyword MajorTopicYN="N">stroke</Keyword></KeywordList><CoiStatement>The authors have declared that no competing interests exist.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>24</Day><Hour>5</Hour><Minute>34</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>9</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>9</Month><Day>25</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32968582</ArticleId><ArticleId IdType="doi">10.7759/cureus.9921</ArticleId><ArticleId IdType="pmc">PMC7505622</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Acta Neurol Scand. 2020 Jul;142(1):14-22</Citation><ArticleIdList><ArticleId 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IdType="pubmed">32343504</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country></list><tree><country name="États-Unis"><noRegion><name sortKey="Bhagat, Riwaj" sort="Bhagat, Riwaj" uniqKey="Bhagat R" first="Riwaj" last="Bhagat">Riwaj Bhagat</name></noRegion><name sortKey="Karki, Bibodh J" sort="Karki, Bibodh J" uniqKey="Karki B" first="Bibodh J" last="Karki">Bibodh J. Karki</name><name sortKey="Liu, Wei" sort="Liu, Wei" uniqKey="Liu W" first="Wei" last="Liu">Wei Liu</name><name sortKey="Narayanan, Siddharth" sort="Narayanan, Siddharth" uniqKey="Narayanan S" first="Siddharth" last="Narayanan">Siddharth Narayanan</name><name sortKey="Remmel, Kerri" sort="Remmel, Kerri" uniqKey="Remmel K" first="Kerri" last="Remmel">Kerri Remmel</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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