• Jin-An Huang, Wen-Hsien Chen, Nien-Chen Liao, Chieh Liang Wu, Yun-Ching Fu, and Po-Lin Chen.
• Division of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Health-Business Administration, Hungkuang University, Taichung, Taiwan.
• J Formos Med Assoc. 2022 Aug 1; 121 (8): 1605-1609.

AbstractPsychiatric and neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are common. Psychiatric symptoms are so common that they are easily misinterpreted as an affective disorder induced by SARSCoV-2 infection. However, psychiatric symptoms, such as acute delirium, though rarely seen, can be the initial manifestations of acute ischemic stroke (AIS). These psychiatric symptoms may confuse the diagnosis of acute stroke, which needs correct and timely management. We report two hospitalized cases with SARS-CoV-2 infection and elevated serum D-dimer levels having acute delirium as the initial manifestation of AIS. The diagnostic processes were challenging and time-consuming, so reperfusion therapy could not be given in the therapeutic time window. The diagnoses of AIS were finally made by brain magnetic resonance imaging which showed diffusion restriction at the right middle cerebral artery territory in both cases. Features of psychiatric complications and stroke in coronavirus disease 2019 (COVID-19) patients are reviewed. For the hospitalized COVID-19 patients with elevated levels of serum Ddimer and acute delirium, acute stroke with neuropsychiatric manifestations should beconsidered.Copyright © 2022 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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