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INTRODUCTION: When treating patients with borderline personality disorder we must take under consideration high risk of self-har and suicidal behaviours.

BRIEF CLINICAL HISTORY: A 19-year-old female with a history of borderline personality disorder and bulimia contacted her GP requesting an urgent visit because of a sudden suicidal ideation, that delivered in a suicidal attempt – the patient jumped under the car on the road in the town, but luckily the driver managed to stop the car without hurting her. As a manifestation of the anger the patient banged her hand against the wall, provoking the fracture of two metacarpal bones. On examination she appeared calm, she declared the will of treatment; according to her words she felt “empty” and “not belonging to anywhere” – that was a direct reason of the suicidal attempt. The Advanced Life Support Ambulance transported the patient immediately to the local University Hospital where she was examined by the psychiatrist. The blood test revealed no drugs except for cannabis. The patient stayed in for 1 day, was attended by the psychiatrist and traumatologist and, finally, was discharged with an appointment for psychologist and psychiatrist for an outpatient clinic for the follow-up.

DIFFERENTIAL DIAGNOSIS: depression, bipolar disorder, psychotic episode

FINAL DIAGNOSIS:suicidal ideation in borderline patient

DISCUSSION: Facing a difficult situation of a patient after a suicidal attempt, we should behave in a discrete, but efficient way. We need to reassure the well-being of our patient and his/her proper treatment. The first step is the psychiatric evaluation, but it is also necessary to consider close follow-ups in our clinic.

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INTRODUCTION:

The COVID-19 disease, the global health threat, is frequently associated with neurological complications, including strokes. The bibliography describing the pathophysiological pathways of those clinical manifestations is increasingly abundant.

BRIEF CLINICAL HISTORY:

A 50-year-old male with a history of arterial hypertension and type 2 diabetes mellitus, without any toxic habits, consulted the E.R., after being hospitalized for COVID-related pneumonia for 8 days, because of hemiparesis of the right upper limb and mixed dysphasia of 8 hours of evolution. The urgent CT-scan was performed, and multiple ischaemic infarcts of early, subacute evolution were found in the left frontal-parietal lobar surface with premotor frontal involvement and in the anterior cortical vascular border territory, described as secondary to COVID-19 infection. Due to the time of evolution and location of the occlusion, the acute-phase treatment was discharged, and the patient was admitted to the Internal Medicine Ward for a conservative treatment.

FINAL DIAGNOSIS:

COVID-19 related ischaemic stroke

DISCUSSION:

Cerebrovascular events, especially ischaemic strokes are frequently related to COVID-19 infection. The hypercoagulability, similar to the one described in septic shock, can be the origin. On the other hand, the COVID-19 binds to ACE-2 (angiotensin-converting enzyme 2) in brain endothelium and cellular membranes, leaving many organs, including the brain itself exposed to the harmful effect of ACE-1. Although, there are some other studies that point out that the ischaemic events cannot be considered as a major complication of COVID-19 infection.

The goal of this review, inspired by the quoted case report, is to exam the clinical, neurological manifestations and pathophysiological pathways.