COVID-19 and acute ischemic stroke – A case series from Dubai, UAE

Khan, Maria; Ibrahim, Rasha Hm; Siddiqi, Shaista Anwar; Kerolos, Youssry; Al-Kaylani, Muhammad; Alrukn, Suhail; Krieger, Derk

doi:10.1177/1747493020938285

Cited by 24 publications

(22 citation statements)

References 9 publications

(9 reference statements)

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“…To our knowledge, this is the first study that compares COVID-19 patients to non-COVID-19 patients within a prospectively collected stroke database. Similar to previous case reports and case-controlled studies, from USA ( 10 ), Iran ( 26 ), Dubai ( 27 ), France ( 28 ) and China ( 8 ), a third of our COVID-19 positive patients had severe disease, required ICU admissions, stayed longer in hospital and had fewer subjects with good outcome. These patients likely represent a subset of stroke patients in whom the viral infection likely contributed to a prothrombotic state resulting in vascular occlusions and large strokes.…”

Section: Discussionsupporting

confidence: 87%

Characteristics and Comparison of 32 COVID-19 and Non-COVID-19 Ischemic Strokes and Historical Stroke Patients

Akhtar

Abid

Kamran

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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Introduction : The presence of COVID-19 infection may increase the risk of thrombotic events including ischemic strokes. Whilst a number of recent reports suggest that COVID-19 associated stroke tends to be severe, there is limited data on the effects of COVID-19 in prospective registries. Patient and Methods : To determine how COVID-19 infection may affect cerebrovascular disease, we evaluated the ischemic stroke sub-types, clinical course and outcomes prior to and during the pandemic in Qatar. The Hamad General Hospital (HGH) stroke database was interrogated for stroke admissions during the last 4 months of 2019 and January-May 2020. Results : In Qatar the number of confirmed cases of COVID-19 increased from only 2 in February to 779 in March, 12,628 in April and 45,501 in May. Stroke admissions to HGH declined marginally from an average of 97/month for six pre-COVID months to 72/month in March – May. There were 32 strokes that were positive for COVID-19. When compared to non-COVID-19 stroke during the three months of the pandemic, COVID-19 patients were younger with significantly lower rates of hypertension, diabetes and dyslipidemia. COVID-19 positive patients had more cortical strokes (34.4% vs 5.6%; p= 0.001), severe disease (NIHSS >10: 34.4% vs 16.7%; p=0.001) prolonged hospitalization and fewer with good recovery (mRS 0-2: 28.1% vs 51.9%; p= 0.001). Conclusions : When compared to six pre-COVID-19 months, the number of ischemic stroke admissions during the three months of the pandemic declined marginally. COVID-19 positive patients were more likely to have a large cortical stroke with severe symptoms and poor outcome.

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Section: Discussionsupporting

confidence: 87%

Characteristics and Comparison of 32 COVID-19 and Non-COVID-19 Ischemic Strokes and Historical Stroke Patients

Akhtar

Abid

Kamran

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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“…To date there are several reports on neurological complications of COVID-19. We divided the neurological symptoms in such patients into three different groups: symptoms related to CNS involvement [ [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , [98] , [99] , [100] , [101]...…”

Section: Resultsmentioning

confidence: 99%

“… Cerebrovascular events 3 Ischemic Stroke 37 Articles [ 39 ], [ 57 ], [ 58 ], [ 60 ], [ 63 ], [ 73 ], [ 74 ], [ 75 ], [ 76 ] [ 77 ], [ 78 ], [ 79 ], [ 80 ],. [ 81 ], [ 82 ], [ 83 ], [ 84 ], [ 85 ], [ 86 ], [ 87 ], [ 88 ], [ 89 ], [ 90 ], [ 91 ], [ 92 ], [ 93 ], [ 94 ], [ 95 ], [ 96 ], [ 97 ], [ 98 ], [ 99 ], [ 100 ], [ 101 ], [ 102 ], [ 178 ], [ 192 ] 363 NR in all articles. In large population studies ischemic stroke was reported in 1% [ 77 ] to 2.5% [ 84 ] of patients.…”

Section: Resultsmentioning

confidence: 99%

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Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Dorche

Huot

Osherov

et al. 2020

Journal of the Neurological Sciences

183

182

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Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications. Methods: This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19. Results: Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported. Conclusion: There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.

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“…In a previously reported series, most of the reported cases ( n = 20; 90.9%) had been diagnosed in males. 3 In terms of the vascular territories, stroke involving the anterior circulation was noted in 13 patients (65%) and in the posterior circulation in 6 patients (27.3%). 3 In addition, stroke as the initial clinical manifestation of COVID-19 was noted in 18 patients (81.8%).…”

Section: Discussionmentioning

confidence: 97%

Common Carotid Artery Occlusion in a Young Patient: Can Large-Vessel Stroke Be the Initial Clinical Manifestation of Coronavirus Disease 2019?

et al. 2020

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Background The occurrence of large-vessel occlusion in young patients with coronavirus disease 2019 (COVID-19) infection has been exceedingly rare. An extensive review of reported studies revealed a few reported cases. In the present report, we have described the clinical presentation, radiological findings, and outcome of large-vessel occlusion in a young patient with COVID-19 and reviewed the pertinent reported data on this condition. Case Description A 31-year-old woman was in her usual state of health until she had presented with a 3-day history of right-sided weakness, slurred speech, and decreased vision. The patient had been taken to several hospitals where she had been treated conservatively with analgesics and discharged. Shortly thereafter, her weakness had become progressive. She had become severely dysarthric and unresponsive. On arrival to the emergency department, her physical examination revealed that she was stuporous, with a Glasgow coma scale of 10 (eye response, 3; verbal response, 2; motor response, 5). The National Institutes of Health Stroke Scale score was 19 on presentation. Brain computed tomography and computed tomography venography revealed an occluded left internal carotid artery and left middle cerebral artery with subacute left middle cerebral artery territory infarction and midline shift. Computed tomography angiography revealed complete occlusion of the left common carotid artery. An emergent decompressive craniectomy was successfully performed. The patient was shifted to the intensive care unit. She was later found to be positive for COVID-19. Conclusions Although rare, patients with COVID-19 can present with large-vessel occlusion. Prompt identification of COVID-19–related coagulopathy is essential to assess young patients with clinical manifestations of infarction.

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COVID-19 and acute ischemic stroke – A case series from Dubai, UAE

Abstract: Normal range: D-dimer <0.5 ng/ml. b Normal range: Ferritin, 15-150 ng/ml. c Normal range: C-reactive protein <5 mg/L.

Cited by 24 publications

References 9 publications

Characteristics and Comparison of 32 COVID-19 and Non-COVID-19 Ischemic Strokes and Historical Stroke Patients

Characteristics and Comparison of 32 COVID-19 and Non-COVID-19 Ischemic Strokes and Historical Stroke Patients

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Common Carotid Artery Occlusion in a Young Patient: Can Large-Vessel Stroke Be the Initial Clinical Manifestation of Coronavirus Disease 2019?

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