Temporal Association Between COVID-19 Immunoglobulin-G Antibody Induced Focal Cerebral Arteriopathy and New-Onset Acute Ischemic Stroke in a Pediatric: Is it Causal or Coincidental?

Focal cerebral arteriopathies, vasculitis, microangiopathies, coagulopathies, and in-situ microthrombi leading to territorial infarction of neural tissues are some of the most recent instances which are reported as a consequence of the infection caused by the novel coronavirus (SARS-CoV-2). Acute ischemic stroke (AIS) is one of the major neurological manifestations that have been linked with COVID-19. We describe a case of a 5-year-old boy who had an acute-onset of bilateral arm and leg weakness due to a posterior circulatory ischemic stroke that was temporally associated with COVID-19 Immunoglobulin-G antibody-induced cerebral arteriopathies and vasculitis. Laboratory examination was suggestive of elevated D-dimer levels to 3302 ng/ml, elevated C-reactive protein to 10 mg/dl, and elevated fibrinogen levels to 433 mg/dl. He had a negative COVID-19 nasopharyngeal polymerase chain reaction and positive COVID-19 serologies. Focal cerebral arteriopathy and AIS were managed by administering early antithrombotics, steroids, and multivitamins. On routine follow-ups, the patient remained free from new neurological and functional deficits. Although many hypotheses are proposed to explain the causal relationship between the two, it could as well be sheer coincidence.