COVID-19 presenting as stroke

Abstract

Acute stroke remains a medical emergency even during the COVID-19 pandemic. Most patients with COVID-19 infection present with constitutional and respiratory symptoms; while others present with atypical gastrointestinal, cardiovascular, or neurological manifestations. Here we present a series of four patients with COVID-19 that presented with acute stroke. Methods: We searched the hospital databases for patients that presented with acute stroke and concomitant features of suspected COVID-19 infection. All patients who had radiographic evidence of stroke and PCR-confirmed COVID-19 infection were included in the study. Patients admitted to the hospital with PCR-confirmed COVID-19 disease whose hospital course was complicated with acute stroke while inpatient were excluded from the study. Retrospective patient data were obtained from electronic medical records. Informed consent was obtained. Results: We identified four patients who presented with radiographic confirmation of acute stroke and PCRconfirmed SARS-CoV-2 infection. We elucidate the clinical characteristics, imaging findings, and the clinical course. Conclusions: Timely assessment and hyperacute treatment is the key to minimize mortality and morbidity of patients with acute stroke. Stroke teams should be wary of the fact that COVID-19 patients can present with cerebrovascular accidents and should dawn appropriate personal protective equipment in every suspected patient. Further studies are urgently needed to improve current understandings of neurological pathology in the setting of COVID-19 infection.

Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

“…A total sample of 8,771 participants was included in the systematic review. These studies were conducted in many countries worldwide including in China ( 13 , 40 , 43 ), France ( 37 , 39 , 48 , 50 ), India ( 42 ), Iran ( 51 ), Italy ( 32 , 33 , 46 ), the Netherlands ( 34 ), Philippines ( 52 ), Spain ( 44 , 53 ), Turkey ( 58 ), UK ( 41 , 55 ), and the USA ( 21 , 35 , 36 , 45 , 47 , 49 , 54 , 56 , 57 ). Out of 27 studies, eight studies were of retrospective cohort study design, 11 were case series, and nine were case reports.…”

“…The numbers of stroke were almost equal for LVO (47 stroke cases in 10 studies) and non-LVO (42 cases in 10 studies). Location of LVOs involved were M1 vessels ( 21 , 37 , 41 , 42 , 44 , 45 , 47 , 53 , 54 ), M2 vessel ( 41 , 42 , 44 , 45 , 47 , 53 ), internal carotid ( 21 , 37 , 42 , 45 , 47 , 53 ), multiteritorial ( 37 , 47 ), posterior cerebral ( 41 , 45 ), basilar ( 37 ), ACA ( 21 , 53 ), and the vertebral artery ( 41 ).…”

Impact of COVID-19 on Neurological Manifestations: An Overview of Stroke Presentation in Pandemic.

“…A recently conducted meta-analysis of 8-studies from China, including 46,248 infected patients showed that the most prevalent co-morbidities were hypertension (17%), diabetes mellitus (8%), followed by cardiovascular diseases (5%) 18,19 . In those reported cases without any vascular factors, the SARS-CoV-2 induced hypercoagulability may be the most important mechanism of the cerebrovascular disease 13,20 .…”

Reply to “Better Safe than Sorry: Interventional Radiology Should Be Prepared for the Coronavirus Disease 2019 Pandemic”

“…It is pertinent to add that there is recent literature describing acute ischemic stroke as being one of the presentations of COVID-19 infection. 2 Finally, we second the statement "better safe than sorry" in this hour of a COVID-19 pandemic.…”