A 14-Year-Old Male Patient with Kawasaki Disease Presented with Stroke after COVID-19

According to several studies, children represent only about 2% of the patients affected by the current SARS-CoV-2, and most often, they are asymptomatic. However, there is a concern about a vascular inflammatory disease which is similar to Kawasaki disease observed in children and adolescents weeks after infection. We report a case of Kawasaki disease presented with ischemic stroke in a 14-year-old male patient following SARS-Cov-2 infection. Case report A 14-year-old male with classical signs of Kawasaki Disease (KD) and no chronic medical condition presented with ischemic stroke. The diagnosis was challenging because the prior COVID-19 was silent and the skin rashes were very prominent on admission. Therefore, the patient was admitted and empirically treated in the clinic of dermatology at first days, and only after complicated with neurological symptoms, he was transferred to the Neurology Clinic. Prior infection with SARS-CoV-2 was confirmed based on serological testing and prior contact with the infected family member. Brain ischemia was confirmed with MRI. Even though there was not any large artery or venous occlusion apparent on CTA, increased pulsatility index was found on the left MCA suggesting distal small diameter arterial segments occlusion. After treatment with IVIG, corticosteroids, and low-dose aspirin, the neurological deficit was resolved. The exact pathomechanism of the Multisystem Inflammatory Syndrome in Children (MIS-C) is not clear. Given the lag between SARS-CoV-2 infection and MIS-C and the finding that many patients are positive for antibodies and negative for the viral antigen, it has been suggested that abnormal immune response might be the key factor. A potential role of the antibodies in the pathogenesis of KD has been accepted, and the prevalence of such antibodies to target different tissues in the body could explain the multisystem presentation in MIS-C [10]. Conclusion There is a myriad of COVID-19 symptoms and sequelae making the diagnosis challenging. Early diagnosis and prompt treatment of the secondary inflammatory syndromes, including Kawasaki disease, is very important for preventing end-organ damage and long-term complications

Hypoglycemia-Induced Hemiparesis in a Diabetic Woman after Childbirth

A 24-year-old female with type 1 diabetes mellitus presented with hemiparesis induced by hypoglycemia. She was hospitalized because she has noticed a weakness of her right hand and leg three days after childbirth. On physical examination she had an expressive dysphasia and right side hemiparesis with facial drop. Hypoglycemia is rarely associated with hemiparesis and it is often overlooked, especially when it happens in patients at higher risk of other diseases frequently associated with hemiparesis. Although sporadical cases of hypoglycemia-induced hemiparesis were reported, the clear pathophysiology behind this is not well determined. However, any individual case is important in order to increase the awareness of hypoglycemia as an important etiology of this condition

Posterior circulation lesions are more frequently associated with early seizures after a stroke

Early seizures (ES) following stroke are prevalent among the elderly population, representing the most common type of acquired seizures. This study aimed to determine the incidence of ES and investigate potential associations with various clinical and radiological factors. 260 stroke patients (mean age 72±13.2, 48.5% females) were prospectively enrolled and followed. Baseline demographic data, clinical data, stroke subtype, ES occurrence, National Institutes of Health Stroke Scale (NIHSS) scores, and Alberta Stroke Program Early CT Score (ASPECT) were collected and analyzed. ES was observed in 11.6% of patients with ischemic stroke compared to 7.1% among patients with hemorrhagic stroke. ES occurred more frequently in those with posterior circulation stroke (18.5% vs. 7.1%, P=0.008) and those with NIHSS >15 (19.4% vs. 8.4%, P=0.04). In a logistic regression analysis that adjusted for vascular risk factors and NIHSS, posterior circulation stroke remained significantly associated with ES, with an odds ratio of 3.14 (95% CI 1.20 to 7.73, P=0.012). This study revealed that ES following stroke is more common in patients with posterior circulation lesions. These findings emphasize the need for further investigation into additional factors that may influence ES occurrence and its impact on stroke management and patient outcomes