COVID-19 Ischemic Strokes as an Emerging Rehabilitation Population

Abstract

There is emerging literature that coronavirus disease 2019 infections result in an increased incidence of thrombosis secondary to a prothrombotic state. Initial studies reported ischemic strokes primarily occurring in the critically ill coronavirus disease 2019 population. However, there have been reports of ischemic strokes as the presenting symptom in young noncritically ill coronavirus disease 2019 patients without significant risk factors. Further characterization of the coronavirus disease 2019 stroke population is needed. We present four cases of coronavirus disease 2019 ischemic strokes occurring in patients aged 37–68 yrs with varying coronavirus disease 2019 infection severities, premorbid risk factors, clinical presentations (eg, focal and nonfocal), and vascular distributions. These cases highlight the heterogeneity of coronavirus disease 2019 ischemic strokes. The duration of the coronavirus disease 2019–related prothrombotic state is unknown, and it is unclear whether patients are at risk for recurrent strokes. With more coronavirus disease 2019 patients recovering and being discharged to rehabilitation, physiatric awareness of this prothrombotic state and increased incidence of ischemic strokes is essential. Because of the variable presentation of coronavirus disease 2019 ischemic strokes, clinicians can consider neuroimaging as part of the evaluation in coronavirus disease 2019 patients with either acute focal or nonfocal neurologic symptoms. Additional studies are needed to clarify prothrombotic state duration, determine prognosis for recovery, and establish the physiatrist’s role in long-term disease management.

Heterogeneity in Regional Damage Detected by Neuroimaging and Neuropathological Studies in Older Adults With COVID-19: A Cognitive-Neuroscience Systematic Review to Inform the Long-Term Impact of the Virus on Neurocognitive Trajectories

“…All cerebral lobes have been reported to be affected by ischaemic events associated with COVID-19 including the frontal lobe (Avula et al, 2020 ; Basi et al, 2020 ; Fan et al, 2020 ; Hernández-Fernández et al, 2020 ; Jillella et al, 2020 ; Katz et al, 2020 ; Mohamud et al, 2020 ; Morassi et al, 2020 ; Papi et al, 2020 ; Tiwari et al, 2020 ; Zayet et al, 2020 ; Zhang et al, 2020 ) with additional involvement of pericentral areas (Mohamud et al, 2020 ; Morassi et al, 2020 ), the temporal lobe (Beyrouti et al, 2020 ; Jillella et al, 2020 ; Mohamud et al, 2020 ; Morassi et al, 2020 ; Papi et al, 2020 ; Tiwari et al, 2020 ; Zhai et al, 2020 ; Zhang et al, 2020 ), fronto-temporal regions (Barrios-López et al, 2020 ; Chen et al, 2020 ; Hernández-Fernández et al, 2020 ; Mohamud et al, 2020 ; Papi et al, 2020 ; Sierra-Hidalgo et al, 2020 ), the parietal lobe (Bolaji et al, 2020 ; Chen et al, 2020 ; Fan et al, 2020 ; Hernández-Fernández et al, 2020 ; Jillella et al, 2020 ; Papi et al, 2020 ; Sierra-Hidalgo et al, 2020 ; Zayet et al, 2020 ; Zhang et al, 2020 ), fronto-parietal regions (Fan et al, 2020 ; Goldberg et al, 2020 ; Jillella et al, 2020 ; Mohamud et al, 2020 ; Morassi et al, 2020 ; Tunç et al, 2020 ; Viguier et al, 2020 ; Zayet et al, 2020 ; Zhang et al, 2020 ), the occipital lobe (Diaz-Segarra et al, 2020 ; Fan et al, 2020 ; Hernández-Fernández et al, 2020 ; Janju...…”

COVID‐19: Neuroimaging Features of a Pandemic

“…Our systematic review revealed a total of 45 studies reporting imaging features of a total of 483 COVID‐19 patients suffering from acute ischemic stroke (AIS) 12,18,21–24,30–67 . A total of 26 studies were presented as single case reports or as case series 30–55 . The remaining 19 studies were conducted as retrospective studies reporting on neuroimaging findings of AIS patients 12,18,21–24,56–66 .…”

Neuropsychiatric Complications of COVID-19

“…Stroke is the most common neurological finding on imaging of hospitalized patients for SARS-CoV-2 [ 19 ]. Stroke can even be a presenting symptom, though is more typically part of multi-organ involvement [ 20 ]. Furthermore, stroke itself is a risk factor for depression, and COVID-19 patients with strokes are at significantly increased risk for poor outcomes [ 21 ].…”