Clinical and Radiological Characteristics of Acute Cerebrovascular Diseases Among Egyptian Patients With COVID-19 in Upper Egypt

Abstract

Background and Purpose: There is little information on the acute cerebrovascular complications of coronavirus disease 2019 (COVID-19) in Egypt. The aim of this study was to estimate the proportion of acute cerebrovascular disease (CVD) among COVID-19 patients and evaluate their clinical and radiological characteristics in comparison with non-COVID-19 CVD.Materials and Methods: In a retrospective study, COVID-19 patients whom presented with CVD in Assiut and Aswan University Hospitals were compared with non-COVID-19, CVD patients, admitted to Qena University Hospital, prior to the pandemic. The following data were collected: clinical history and presentation, risk factors, comorbidities, brain imaging (MRI or CT), chest CT, and some laboratory investigations.Results: Fifty-five (12.5%) of the 439 patients with COVID-19 had acute CVD. Of them, 42 (9.6%) had ischemic stroke while 13 patients (2.9%) had hemorrhagic CVD. In the 250 cases of the non-COVID-19 group, 180 had ischemic stroke and 70 had hemorrhagic stroke. A large proportion of patients with COVID-19 who presented with ischemic stroke had large vessel occlusion (LVO), which was significantly higher than in non-COVID-19 patients with CVD (40 vs. 7.2%, P < 0.001). Comorbidities were recorded in 44 (80%) cases. In COVID-19 ischemic stroke patients, risk factors [hypertension and ischemic heart disease (IHD)] and comorbidities (hepatic and renal) were significantly higher than those in non–COVID-19 patients. In addition, 23.5% had hemorrhagic CVD, and six patients with LVO developed hemorrhagic transformation.Conclusion: Acute CVD among patients with COVID-19 was common in our study. LVO was the commonest. Hypertension, IHD, and anemia are the most common risk factors and could contribute to the worsening of clinical presentation. Comorbidities were common among patients with CVD, although a large number had elevated liver enzymes and creatinine that were partially due to COVID-19 infection itself. The current results begin to characterize the spectrum of CVD associated with COVID-19 in patients in Upper Egypt.Registration ID: The ID number of this study is IRB no: 17300470.

Large Vessel Occlusion Causing Cerebral Ischemic Stroke in Previously Healthy Middle-Aged Recently Recovered from Severe COVID-19 Infection

“…16 This could be explained by the fact that patients with COVID-19 have a significantly higher incidence of hemorrhagic transformation compared with their non-infected counterparts. 17 Although the hemorrhagic transformation might be a potential complication of thrombolytic therapy, it is unlikely since the patient was eligible for the treatment and did not have any risk factors for bleeding.…”

Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review

“…Some studies have proposed even greater incidence of cryptogenic stroke close to 50%, which may be attributed to cerebral endothelitis [ 72 , 73 ]. In other cohorts, an increased incidence of LVO has been noted, varying from 40% [ 28 , 74 ] to 60% [ 75 , 76 ].…”

Recombinant tissue plasminogen activator (rTPA) management for first onset acute ischemic stroke with covid -19 and non-covid -19 patients

“…Acute cerebrovascular stroke (CVS), particularly ischemic, is a common critical complication of COVID-19, 4 with a tendency for major vessel occlusion, multi-territory stroke, and involvement of otherwise rarely afflicted arteries. The pathophysiology and effective management of ischemic stroke caused by COVID-19 are as yet unknown, although increasing data indicates that cytokine storm-induced coagulopathy and endotheliopathy are potential targetable pathways.…”