Cerebrovascular Complications of COVID-19

Abstract

Background and Purpose: Coronavirus disease 2019 (COVID-19) evolved quickly into a global pandemic with myriad systemic complications, including stroke. We report the largest case series to date of cerebrovascular complications of COVID-19 and compare with stroke patients without infection. Methods: Retrospective case series of COVID-19 patients with imaging-confirmed stroke, treated at 11 hospitals in New York, between March 14 and April 26, 2020. Demographic, clinical, laboratory, imaging, and outcome data were collected, and cases were compared with date-matched controls without COVID-19 from 1 year prior. Results: Eighty-six COVID-19–positive stroke cases were identified (mean age, 67.4 years; 44.2% women). Ischemic stroke (83.7%) and nonfocal neurological presentations (67.4%) predominated, commonly involving multivascular distributions (45.8%) with associated hemorrhage (20.8%). Compared with controls (n=499), COVID-19 was associated with in-hospital stroke onset (47.7% versus 5.0%; P <0.001), mortality (29.1% versus 9.0%; P <0.001), and Black/multiracial race (58.1% versus 36.9%; P =0.001). COVID-19 was the strongest independent risk factor for in-hospital stroke (odds ratio, 20.9 [95% CI, 10.4–42.2]; P <0.001), whereas COVID-19, older age, and intracranial hemorrhage independently predicted mortality. Conclusions: COVID-19 is an independent risk factor for stroke in hospitalized patients and mortality, and stroke presentations are frequently atypical.

Insights Into Neuroimaging Findings of Patients With Coronavirus Disease 2019 Presenting With Neurological Manifestations

“…In a retrospective COVID-19 study, patients with leukoencephalopathy or cerebral micro-hemorrhages had higher peak D-dimer levels and peak international normalized ratio, lower Glasgow Coma Scale and nadir platelet count, longer ventilation time, and hospitalization, more severe acute respiratory distress syndrome, and worse functional status on discharge compared with patients who had normal brain MRI findings (47). When comparing COVID-19 patients with non-COVID-19 patients, increased frequency of in-hospital stroke onset was found in the former cohort (48 vs. 5%) (32).…”

“…Small cortical ischemic lesions were revealed by MRI in a COVID-19 patient while neither interstitial lung involvement nor abnormal serum inflammation markers were detected (31). Furthermore, a multicenter retrospective study comparing COVID-19 patients with non-COVID-19 patients from 1 year prior found that infection with COVID-19 was the strongest independent risk factor for stroke, followed by deep vein thrombosis and male sex (32). Micro-hemorrhages are best visualized by SWI, presenting as hypoattenuating foci.…”

Ischemic stroke in COVID-19-positive patients: an overview of SARS-CoV-2 and thrombotic mechanisms for the neurointerventionalist

“…3 28-30 Furthermore, three studies have found COVID-19 infection to be an independent risk factor for both acute ischemic stroke and LVO. [31][32][33] The COVID-19 paradox…”

Increased ethnicity and socioeconomic data collection required in stroke associated with COVID-19

“…Stroke is a rare but well-documented complication, with most prevalence estimates varying slightly around 0.8%. 2 It is therefore important to elucidate both those at risk of developing stroke and stratifying those at risk of more severe outcomes when stroke occurs.…”

“…Could it be due to increased prevalence of COVID-19 in BAME groups? 2 Or are BAME populations at relatively greater risk of severe outcomes, including stroke, after COVID-19? 4 Through curation of our blog, we have noted that many studies of stroke in the context of COVID-19 infection are published each week.…”