Introduction: Corona virus disease is an infectious disease caused by Sars-cov2 virus. It predominantly affects respiratory system causing fever, cough, breathlessness. But it can also affects central nervous system. Clinicians must adopt methodical approach in investigating a patient with neurological manifestation.

Case Report: 65 years old female presented to us with right sided weakness of upper limb and lower limb, loss of speech  since 4 days. High grade fever since 3 days.   Dry cough since 2 days. No history of comorbidities. On examination, patient was conscious, obeying to commands. Vitals was stable, except respiratory rate was 28 breaths per minute. Temperature was 100 deg Fahrenheit. Oxygen saturation was 92 percent room air. CNS examination, patient had motor aphasia. Power of 2/5 and hypotonia of right upper and lower limb. Right plantar reflex was extensor.  ABG revealed  type 1 respiratory failure. NLR was 1.01, d-dimer was 4.8, serum CRP was 27mg/dl, interleukin-6 was 0.18pg/ml. ECG showed sinus tachycardia. Chest x ray showed bilateral lower and mid zone infilterates, predominantly peripheries. RT-PCR for Sars-Cov 2 was positive. CT brain plain revealed left inferofrontal and parieto-occipital infarct.

Final Diagnosis:  Acute Ischemic stroke with Covid-19 pneumonia.

Discussion: Even though respiratory symptoms predominantly seen in covid 19 patients, our patient presented with right hemiparesis with motor aphasia. Her CRP and d-dimer was elevated. This indicates that Sars cov2 has increased affinity towards the ACE2 receptors which are expressed in  endothelium and arterial smooth muscle cells in the brain,  resulting in inflammatory process, endothelial dysfunction and prothrombotic state causing acute ischemic stroke.

Conclusion: Covid 19 infection can be the independent risk factor for developing acute ischemic stroke due to  pro-thrombotic state. Early detection and treatment is required for neurological disease of  covid 19 to reduce post covid neurological sequel.

Keywords: Stroke, Covid 19, D-dimer, CRP

Abbreviations : Sars-cov2 : Severe respiratory distress syndrome- corona virus 2, ABG : Arterial blood gas analysis, NLR : Neutrophil lymphocyte ratio, CRP :C reactive protein, RT-PCR : reverese transcriptase – polymerase chain reaction, ACE -2 : Angiotensin converting enzyme 2