COVID-19-related strokes in adults below 55 years of age: a case series

Abstract

Background Coronavirus infection is a novel respiratory disease affecting people across the world. Although the majority of patients present with fever, dyspnea, cough, or myalgia, various signs and symptoms have been reported for this disease. Recently, neurological symptoms have been noticed in patients with COVID-19 with unknown etiology. However, the occurrence of strokes in young and middle aged patients with COVID-19 is not fully explained. Methods In this series, six patients younger than 55 years of age with diagnosis of stroke and a confirmed diagnosis of COVID-19 were evaluated for symptoms, lab data, imaging findings, and outcomes from March 2020 to the end of April 2020 from all stroke cases in a tertiary academic hospital. Patients older than 55 and all others who had evidence of cardiac abnormalities (arrhythmia/valvular) were excluded. Results Fever, myalgia, cough, and dyspnea were the most common clinical symptoms noted in 66.66% (4/6), 66.66% (4/6), 50% (3/6), and 50% (3/6) of the patients, respectively. The mean ± standard deviation (SD) of National Institutes of Health Stroke Scale (NIHSS) for the patient was 10.16 ± 7.13 (ranged 5-24). The most involved area was middle cerebral artery (MCA) (five in MCA versus one in basal ganglia) and the majority of our patients had a low lung involvement score (mean ± SD: 13.16 ± 6.49 out of 24). Finally, one patient was deceased and rest discharged. Conclusion Stroke may be unrelated to age and the extent of lung involvement. However, different factors may play roles in cooccurrence of stroke and COVID-19 and its outcome. Future studies with long-term follow-up and more cases are needed to assess prognostic factors.

Studying the neuropsychological sequelae of SARS-CoV-2: lessons learned from 35 years of neuroHIV research

“…Five younger (< 50 years old) patients presented with large-vessel stroke within a 2-week period at a New York City hospital, where historically an average of only 0.73 patients under 50 were treated for the condition during the same time frame over the previous 12 months (Oxley et al 2020). A similar case series, describing six patients with stroke under the age of 55, was recently reported from Iran (Ashrafi et al 2020).…”

The Association of Cerebrovascular Disease with Adverse Outcomes in COVID-19 Patients: A Meta-Analysis Based on Adjusted Effect Estimates

“… 30 To our knowledge, several meta-analyses have investigated the association of cerebrovascular disease with the adverse outcomes in COVID-19 patients, 5 , 31 , 32 however, the data were uniformly estimated based on unadjusted effect estimates. As reported in previous studies, age, gender and pre-existing disease conditions could affected disease progression of COVID-19, 7 , 8 , 9 , 10 and might modulate the association between cerebrovascular disease and the adverse outcomes in COVID-19 patients. Therefore, it is an urgent need to verify this association by performing a quantitative meta-analysis based on adjusted effect estimates.…”

“…This suggested that the association between cerebrovascular disease and adverse outcomes in COVID-19 patients might be affected by many confounders such as age, gender, and other comorbidities. 7 , 8 , 9 , 10 Therefore, this meta-analysis was performed to evaluate the association between cerebrovascular disease and adverse outcomes in COVID-19 patients on the basis of adjusted effect estimates.…”

COVID-19 and its impact on neurological manifestations and mental health: the present scenario

“…Farzad et al reported a series of six patients younger than 55 years of age affected with COVID-19 and diagnosed with stroke. Brain CT scan findings of the patients revealed right middle cerebral artery (MCA) infarction (n = 3), left MCA (n = 2) and left basal ganglia infarction (n = 1), and the majority of the patients had large vessel stroke [42].…”