To report a unique case with recurrent strokes over a 2-month period secondary to COVID-19 infection. 

COVID-19 is associated with hypercoagulability and increased risk of acute ischemic strokes (AIS).      The duration of the risk is unknown.  We report a case of recurrent strokes within 8 weeks following COVID-19 infection despite recovery from respiratory symptoms.

72-year-old male who presented to our hospital with sudden onset right-sided numbness and weakness. He had fever, cough and loss of taste 8 weeks before presentation, and had tested positive for COVID-19 then. He developed mild left-sided weakness 2 days after testing positive which recovered within a few days, and he did not seek medical attention. He is hypertensive and on Plavix. He had stable BP, intact higher mental function, no cortical signs and NIHSS of 3 because of numbness, weakness and facial palsy.

MRI brain showed acute infarcts in the left thalamus, left pons, in addition to bilateral linear diffusion restriction in the parietal lobe along the post-central gyri. Multiple strokes were seen on FLAIR of different ages corresponding to within 8 weeks onset, including the right pons which would explain the right-sided weakness at the time of COVID diagnosis. He had normal CTA, normal Echo and normal 30-days holter monitoring. He had no Covid symptoms, and COVID-19 testing was negative. Labs showed persistently elevated inflammatory markers including d-dimer and ferritin.

There have been several proposed mechanisms for AIS in COVID-19 infection including hypercoagulability and new-onset atrial fibrillation leading to embolic strokes, vasculitis secondary to intracranial cytokine storm, and infection by the virus itself. Associated elevated ferritin, d-dimer, high-sensitivity troponin and proBNP have been consistently reported. Our case suggests that the hyper-inflammatory state may persist even after the recovery of respiratory symptoms, and AIS can be a late complication of COVID-19.