BackgroundThe coronavirus disease (COVID-19) pandemic has led to an unprecedented worldwide burden of disease. However, little is known of the longer-term implications and consequences of COVID-19. One of these longer-term complications is a COVID-19 associated coagulopathy that can present as a venous thromboembolism (VTE) and, as yet unreported, multiple paradoxical cerebral emboli. Case PresentationA 51 year old man presented to the emergency department with multiple simultaneous embolic

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... bral infarctions 11 months after mild COVID-19. In the subacute phase of the COVID-19 illness the patient developed increasing shortness of breath and was found to have an elevated D-dimer and multiple bilateral segmental pulmonary emboli. He was subsequently treated with 3 months of anticoagulation for a provoked VTE. The patient then presented 11 months after the initial COVID-19 diagnosis with multiple simultaneous cerebral infarctions where no traditional underlying stroke etiology was determined. A patent foramen ovale (PFO) and an elevated D-dimer were found indicating a paradoxical thromboembolic event due to an underlying coagulopathy. ConclusionsThis case report highlights the one of the potentially more serious complications of long-term COVID-19 where VTE due to a persistent coagulopathy is seen almost a year after the initial illness. Due to the highly prevalent nature of PFO in the general population, VTE due to COVID-19 associated coagulopathy could lead to ischemic stroke. This case report therefore highlights the challenge posed by the underlying COVID-19 associated coagulopathy which can persist for many months and beyond from the initial illness.