COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature

Abstract

Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection. Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain. We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients. A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020. All studies reporting AIS occurrence in COVID-19 patients were included. A total of 39 studies comprising 135 patients were studied. The pooled incidence of AIS in COVID-19 patients from observational studies was 1.2% (54/4466) with a mean age of 63.4 ± 13.1 years. The mean duration of AIS from COVID-19 symptoms onset was 10 ± 8 days, and the mean NIHSS score was 19 ± 8. Laboratory investigations revealed an elevated mean d -dimer (9.2 ± 14.8 mg/L) and fibrinogen (5.8 ± 2.0 g/L). Antiphospholipid antibodies were detected in a significant number of cases. The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62.1%, 64/103), followed by multiple vascular territory (26.2%, 27/103). A high mortality rate was reported (38.0%, 49/129). We report the pooled incidence of AIS in COVID-19 patients to be 1.2%, with a high mortality rate. Elevated d -dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis. Electronic supplementary material The online version of this article (10.1007/s11239-020-02228-y) contains supplementary material, which is available to authorized users.

Stroke in COVID-19: A systematic review and meta-analysis

“…While some authors have focused on the relationship between personal history of CVD and COVID-19(7, 8), we studied the incidence and risk factors for the occurrence of new CVD in concomitant SARS-CoV2 infection, searching for a specific profile of COVID-19associated stroke. We found a similar rate of stroke incidence in COVID-19 compared to previous reports, but included a higher number of cohort studies(34,35). We provide a comprehensive picture of the clinical, biochemical and radiological features of stroke in COVID-19; in comparison to other reviews(36,37), this was done after excluding case reports and small case series (which may be biased through focusing on particularly unusual cases), thus strengthening the solidity of our results.…”

“…Secondly, the characteristic pattern of stroke in individuals with COVID-19, with an increased proportion of large artery occlusion, infarction involving multiple territories, and increased cryptogenic aetiology, suggests a causal relationship in at least a proportion of patients.Previous reports have been published with the attempt to clarify the relationship between stroke and COVID-19. These included narrative reviews(32,33), systematic reviews(9)(10)(11)34) and metaanalyses(34,35). While some authors have focused on the relationship between personal history of CVD and COVID-19(7, 8), we studied the incidence and risk factors for the occurrence of new CVD in concomitant SARS-CoV2 infection, searching for a specific profile of COVID-19associated stroke.…”

Schlaganfall und COVID-19

“…Mehrere Studien zeigten, dass die Inzidenz von Schlaganfällen bei Patienten mit COVID-19 zwischen 0,9% und 2,7 % liegt [4]. Die COVID-19-Infektion führt primär zu einer schweren interstitiellen Pneumonie.…”

“…Unabhängig von dem Vorliegen der Infektion wurden Patienten, die im entsprechenden Zeitfenster kamen, mit einer systemischen Thrombolyse behandelt bzw. thrombektomiert [4].…”

Acute Ischemic and Hemorrhagic Stroke in COVID-19: Mounting Evidence

“…Another equally concerning feature of COVID-19 is the involvement of the central nervous system, which may vary from headaches, dizziness, hypogeusia, or encephalitis owing to direct viral invasion of neural tissue, to cerebrovascular disease or stroke [2,4]. The incidence of both acute ischemic stroke and hemorrhagic in COVID-19 patients is reported to range from 1% to 6% [5][6][7][8][9][10]. The acute brain infarction secondary to stroke is of particular importance because it not only substantially affects the prognosis of the patient but can also have long-term residual neurological deficits.…”