Ischemic Stroke Occurs Less Frequently in Patients With COVID-19

Bekelis, Kimon; Missios, Symeon; Ahmad, Javaad; Labropoulos, Nicos; Schirmer, Clemens M.; Calnan, Daniel R.; Skinner, Jonathan; MacKenzie, Todd A.

doi:10.1161/strokeaha.120.031217

Cited by 66 publications

(63 citation statements)

References 23 publications

(38 reference statements)

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“…The proposed mechanisms for stroke include hypoxemia and inflammation. It has been hypothesized that COVID-19 infection-induced hypoxemia and release of inflammatory cytokines cause cell ischemia and tissue damage including apoptosis [5]. The mean duration of AIS from the onset of COVID-19 symptoms as reported in the literature is 10 ± 8 days which suggests delayed presentation and is similar to the timeline in our case.…”

Section: Discussionsupporting

confidence: 85%

Development of acute ischemic stroke and seizure in a patient with COVID-19 disease: A case report

Upadhyay¹,

Parikh²,

Chavda³

et al. 2021

IJCR

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T he coronavirus disease 2019 (COVID-19) is a viral infection primarily infecting the respiratory tract and is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It affects multiple organs including the nervous system [1]. Acute ischemic stroke (AIS) is a life-threatening central nervous system (CNS) complication of COVID-19 infection primarily mediated by inflammation, direct endothelial dysfunction, thrombin generation, and platelet activation [2]. According to a report the World Stroke Organization, the risk of ischemic stroke during COVID-19 infection is around 5% [3].This case report highlights the development of AIS post-COVID-19 infection complicated by hemorrhagic conversion and seizure. AIS can be a presenting feature of COVID-19 infection and should be kept as a differential diagnosis in patients with a strong clinical suspicion of COVID-19 infection. CASE REPORTA 50-year-old male presented with complaints of fever, breathlessness on exertion, and generalized weakness for a period of 4 days. His family and medical history were unremarkable.On examination, his temperature was 99 F, pulse rate was 96 beats/min, blood pressure was 120/80 mmHg, respiratory rate was 26/min, and oxygen saturation was 88% on a non-rebreather mask with bilateral reduced air entry and basal lung crepitations.The COVID-19 Reverse Transcription Polymerase Chain Reaction test was positive and the chest Computed Tomography (CT) scan showed multiple areas of ground-glass opacities, interstitial septal thickening, and consolidations involving bilateral lung parenchyma. The COVID-19 Reporting and Data System Score(CO-RADS) and the CT severity score were 5 and 15/25 respectively. These clinical and radiological features were consistent with the changes of COVID-19.The patient was intubated in the intensive care unit for continued respiratory distress and hypoxia. The total leukocyte count was 13,000/mm 3 (90% neutrophils), C-reactive protein was 51 mg/dL, prothrombin time was 79.90 s, activated partial thromboplastin time was 40 s, procalcitonin was 2.23 ng/ml, and fibrinogen was 803 mg/dl. He was prescribed remdesivir, tocilizumab, meropenem, colistin, and fluconazole.On the 10 th day of hospitalization, he complained of the leftsided facial deviation, right upper and lower limb weakness. Physical examination showed impaired higher motor functions, right homonymous hemianopia, left gaze preference, right upper limb and lower limb flaccid weakness, right plantar extensor reflex, deep tendon reflexes 2+ in all limbs, and no signs of meningeal irritation. The National Institutes of Health Stroke Scale (NISS) score was 21 signifying severe stroke.

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Section: Discussionsupporting

confidence: 85%

Development of acute ischemic stroke and seizure in a patient with COVID-19 disease: A case report

Upadhyay¹,

Parikh²,

Chavda³

et al. 2021

IJCR

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“…Of those that were negative for SARS-CoV-2 infection, 2.4% (544/22295) presented with an acute ischemic stroke. Mortality for COVID-19 positive patients with stroke appears to be 31.8% as compared with 4.6% for COVID-19-negative patients with stroke and this is hypothesize to be due to respiratory impact of COVID-19 on an already compromised patient with stroke [8]. We also observed the same as our patient died on the second day of discharge from the hospital.…”

Section: Discussionsupporting

confidence: 66%

Acute Ischemic Stroke in COVID-19 Patient with Lung Collapse: A Case Report

Nawazish

Iqbal

Butt

2021

AJRID

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Novel corona virus 2019 also known as severe acute respiratory syndrome coronavirus 2 [SARS COV2] is enveloped non segmented ribonucleic acid (RNA) virus. Acute ischemic stroke remains emergency during covid19 pandemic [1] Here we present a case of a woman with COVID 19 who presented to us with symptoms of altered state of consciousness (ASOC), cough, fever, dysarthria, right sided body weakness and massive bilateral middle cerebral artery (MCA)/ anterior. Our case was unique in the sense that it showed drastic central nervous system (CNS) damage in the presence of coronavirus infection. There are a few cases of patients who develop stroke after COVID 19 infection. Aims: Clinicians need to be aware of possible causes of unconsciousness in coronavirus disease (COVID 19) patients, particularly as delirium appears to be common complications to find out the association between stroke and COVID 19 and its impact and mortality. Case Presentation: A 70 years old lady presented to us with symptoms of stroke like ASOC, right sided body weakness, dysarthria, and symptoms of pneumonia like mild cough and fever later which turned out to be COVID 19. Clinicians need to be aware of possible causes of unconsciousness in coronavirus disease (COVID 19) patients, particularly as delirium appears to be common complications to find out the association between stroke and COVID 19 and its impact and mortality. Discussion: Bilateral ischemic stroke is relatively uncommon presentation in general population and is usually the result of cardio embolic cause such as atrial fibrillation and recent myocardial infarction. While this patient had pre existing risk factors for stroke such as type 2 diabetes mellitus, hypertension and old age and her electrocardiography showed sinus rhythm. Conclusion: COVID-19 may be a risk factor or aggravating factor for stroke.

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“…The first report from our Multinational COVID-19 Stroke Study Group and recent meta-analyses on reported infected patients presented a stroke incidence rate of 0.5–1.4% [ 20 , 21 , 22 ]. The odds of stroke after SARS-CoV-2 may not be greater than in non-infected patients [ 23 ]. In addition, meta-analyses of the reported patients presented that SARS-CoV-2 infected patients who experienced a stroke had a mean age of over 65 years, carried a load of comorbidities, and were affected by more severe infections [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group

Shahjouei

Anyaehie

Koza

et al. 2021

JCM

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Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6–14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8–40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4–36.2) were associated with cardioembolic stroke. Conclusions. Although a cohort of young and healthy men with cardioembolic and large vessel occlusions can be distinguished using both clinical sub-grouping and unsupervised clustering, stroke in other patients may be explained based on the existing comorbidities.

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Ischemic Stroke Occurs Less Frequently in Patients With COVID-19

Cited by 66 publications

References 23 publications

Development of acute ischemic stroke and seizure in a patient with COVID-19 disease: A case report

Development of acute ischemic stroke and seizure in a patient with COVID-19 disease: A case report

Acute Ischemic Stroke in COVID-19 Patient with Lung Collapse: A Case Report

SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group

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