COVID-19 and Stroke: Incidence and Etiological Description in a High-Volume Center

Abstract

Background An increased rate of thrombotic events has been associated to Coronavirus Disease 19 (COVID-19) with a variable rate of acute stroke. Our aim is to uncover the rate of acute stroke in COVID-19 patients and identify those cases in which a possible causative relationship could exist. Methods We performed a single-center analysis of a prospective mandatory database. We studied all patients with confirmed COVID-19 and stroke diagnoses from March 2 nd to April 30 th . Demographic, clinical, and imaging data were prospectively collected. Final diagnosis was determined after full diagnostic work-up unless impossible due to death. Results Of 2050 patients with confirmed SARS-CoV-2 infection, 21 (1.02%) presented an acute ischemic stroke 21 and 4 (0.2%) suffered an intracranial hemorrhage. After the diagnostic work-up, in 60.0% ischemic and all hemorrhagic strokes patients an etiology non-related with COVID-19 was identified. Only in 6 patients the stroke cause was considered possibly related to COVID-19, all of them required mechanical ventilation before stroke onset. Ten patients underwent endovascular treatment; compared with patients who underwent EVT in the same period, COVID-19 was an independent predictor of in-hospital mortality (50% versus 15%; Odds Ratio, 6.67; 95% CI, 1.1-40.4; p 0.04). Conclusions The presence of acute stroke in patients with COVID-19 was below 2% and most of them previously presented established stroke risk factors. Without other potential cause, stroke was an uncommon complication and exclusive of patients with a severe pulmonary injury. The presence of COVID-19 in patients who underwent EVT was an independent predictor of in-hospital mortality.

Risk, clinical course and outcome of ischemic stroke in patients hospitalized with COVID-19: a multicenter cohort study

“…The overall incidence of ischemic stroke of 1.8% in hospitalized patients with COVID-19 is in line with previously published hospital-based COVID-19 cohorts, which reported cumulative incidences ranging between 1.0% and 2.4%. [3][4][5] Lower stroke rates have been found in studies that reported on a combination of hospitalized and non-hospitalized patients. 6,23 Higher rates of up to 6.9% have been reported in populations consisting of ICU patients alone or in other selected patient populations.…”

“…First, most studies were performed in Asia and North America, with only a few European cohorts. [3][4][5]7 Geographical variation may explain some of the heterogeneity, with a higher incidence reported in Asia than in North America and Europe. 3 In addition, regional differences in COVID-19 surges may have resulted in a higher threshold for seeking medical attention in some pandemic areas, especially for patients with mild symptoms of stroke.…”

“…The occurrence of ischemic stroke varied greatly, ranging from 0.01% to 6.9%. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] This may be explained in part by differences in study design, size, case-findings methods, and settings.…”

“…2 Several studies have found that patients with COVID-19 who had acute ischemic stroke were more likely to die. [3][4][5] It remains unclear whether this association with an increased mortality is driven by disease severity and the prothrombotic state triggered by COVID-19. Alternatively, other confounding factors, such as impeded functional recovery due to fever and infection and withdrawal of care in patients with COVID-19 and ischemic stroke, may also play a role.…”

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

“…In a Chinese cohort of 214 confirmed COVID-19 patients, CVD was seen in six patients (2.8%) (2). Requena et al (15) reported 21 (1.02%) cases with an acute ischemic stroke and four (0.2%) with an intracranial hemorrhage in a sample of 2,050 patients with confirmed SARS-CoV-2. In a systematic review of 80 COVID-19 articles, Fraiman et al (16) found a total of 226 cases of ischemic stroke, 35 cases of intracranial bleeding, and 14 cases of venous sinus thrombosis.…”