BACKGROUND: The COVID-19 pandemic, which broke out in Wuhan in 2019, has become the global health crisis of our time . Elderly patients with certain fundamental diseases are more likely to develop severe cases . The secondary lesion following viral infection have only rarely been reported .

CASE PRESENTATION: We here report two cases of coronavirus-infected pneumonia with acute ischemic stroke in middle-aged patients . In both COVID-19 cases, neurological physical examinations showed normal results before infection . Lymphocytopenia, accompanied by elevated cytokines and D-dimers, were found from serum clinical laboratory examination at admission . Dysarthria and limb muscle weakness are initial manifestations, occurring one week after infect-causative pathogen, SARS-CoV-2 . The head CT and head/neck arterial CTA showed small-vessel occlusion . The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke . They were treated with tirofiban and followed up with daily aspirin and atorvastatin .

CONCLUSIONS: These cases suggested that secondary ischemic stroke, mainly manifested as small-vessel occlusion, should be considered for COVID-19 patients and diagnosed and treated promptly.