Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights in a Brazilian Stroke Center

Abstract

Introduction: More than three years into the ongoing pandemic, cerebrovascular accidents (CVAs), commonly known as strokes,have been extensively documented as a potential complication of COVID-19. Methods: Between the first and second epidemiologicalwaves of deaths, our service recorded 1,461 cases of acute respiratory syndrome with positive tests for the COVID-19 virus.During the same period, 595 patients were reported with hospitalizations/complications related to cerebrovascular syndromes.The study included a cohort of 17 patients experiencing cerebrovascular incidents, with ischemic strokes in 10 cases andhemorrhagic strokes in 7 cases. Results: The mean age was 59.8 years with a standard deviation of 14.6 years, and there was aslight female predominance with 9 female patients (52.9%). A substantial majority, 88.2%, were residents of São Paulo. It isnoteworthy that the patients with neurovascular syndrome included in the study primarily presented with symptomscharacteristic of an influenza-like syndrome (fever and cough in 64% of the cases, dyspnea in 53% of the cases), and none reportedanosmia or hyposmia as a primary complaint initially. Concerning cardiovascular risk factors, the following conditions wereassociated with cerebrovascular events: hypertension was present in 64.7% of cases, diabetes mellitus in 52.9%, active smoking in23.5%, chronic kidney disease in 11.8%, and obesity in 11.8%. Another remarkable observation from the evaluation of the selectedpatients, which has become a common finding in epidemiological studies on strokes and COVID-19, is the high rate of patientsrequiring hospitalization (88.2%). Of these hospitalized individuals, 80% required intensive care unit (ICU) support. In our caseseries, all of these (100%) presented with severe COVID-19 infection, secondary bacterial infection, as well as the necessity formechanical ventilation. Furthermore, of those admitted to the ICU, 73.3% developed acute kidney injury requiring hemodialysis,and a similar proportion succumbed to the illness (73.3%). Conclusion: Based on current evidence, the causal relationship betweencerebrovascular events and COVID-19 remains inconclusive. However, it is important to remain vigilant regarding well-establishedfacts, such as the presence of acute inflammation in response to COVID-19 infection.