To study the cause of prolonged altered sensorium following cessation of sedation in mechanically ventilated patients

Patients with severe COVID-19 are at risk of thrombotic complications such as deep vein thrombosis, pulmonary thromboembolism, myocardial infarction and stroke. The incidence of strokes following COVID-19 is reported to be around 1.2%. There has been an increased incidence of large vessel strokes, especially, in young patients without any known risk factors in patients with COVID-19.

We report four cases of stroke diagnosed following neuroimaging in patients with severe COVID-19 Acute respiratory distress syndrome (ARDS). 

All the patients were receiving supportive treatment and mechanical ventilation at the time of diagnosis of stroke. All patients received sedation and paralytics during mechanical ventilation. Poor response to stimulation and inability to wake up after sedation had worn off prompted neuroimaging in these patients, which revealed stroke. Incidentally, all these patients had hypernatremia at the time of diagnosis of stroke. 

This case series suggests that stroke should be considered in all COVID-19 patients who continue to have altered sensorium even after the cessation of sedation.