Outcomes and Spectrum of Major Neurovascular Events Among COVID-19 Patients: A 3-Center Experience

Abstract

BACKGROUND Preliminary data suggest that Coronavirus Disease-2019 (COVID-19) is associated with hypercoagulability and neurovascular events, but data on outcomes is limited. OBJECTIVE To report the clinical course and outcomes of a case series of COVID-19 patients with a variety of cerebrovascular events. METHODS We performed a multicentric, retrospective chart review at our three academic tertiary care hospitals, and identified all COVID-19 patients with cerebrovascular events requiring neuro-intensive care and/or neurosurgical consultation. RESULTS We identified 26 patients between March 1 and May 24, 2020, of whom 12 (46%) died. The most common event was a large-vessel occlusion (LVO) in 15 patients (58%), among whom 8 died (8/15, 53%). A total of 9 LVO patients underwent mechanical thrombectomy, of whom 5 died (5/9, 56%). A total of 7 patients (27%) presented with intracranial hemorrhage. Of the remaining patients, 2 had small-vessel occlusions, 1 had cerebral venous sinus thrombosis, and another had a vertebral artery dissection. Acute Respiratory Distress Syndrome occurred in 8 patients, of whom 7 died. Mortalities had a higher D-dimer on admission (mean 20 963 ng/mL) than survivors (mean 3172 ng/mL). Admission Glasgow Coma Scale (GCS) score was poor among mortalities (median 7), whereas survivors had a favorable GCS at presentation (median 14) and at discharge (median 14). CONCLUSION COVID-19 may be associated with hemorrhage as well as ischemia, and prognosis appears poorer than expected—particularly among LVO cases, where outcome remained poor despite mechanical thrombectomy. However, a favorable neurological condition on admission and lower D-dimer may indicate a better outcome.

Internal Carotid Artery Thrombosis in COVID 19. Case report.

“…A multicenter study of 26 patients with COVID-19 and ischemic or hemorrhagic events reported that 27% were younger than 50 years 20 . In addition, the report indicated that two of the 15 patients with great vessel stroke were younger than 50 years and no prior stroke risk factors.…”

“…Un estudio multicéntrico de 26 pacientes con COVID-19 y eventos isquémicos o hemorrágicos informó que el 27% eran menores de 50 años 20 . Además, el informe indicó que dos de los 15 pacientes con accidente cerebrovascular de gran vaso eran menores de 50 años y no tenían factores de riesgo de accidente cerebrovascular previos.…”

COVID-19 related stroke in young individuals

“… 12 A multicentre series of 26 patients with COVID-19 and either ischaemic or haemorrhagic events reported that 27% were younger than 50 years. 16 Additionally, the report stated that two of 15 patients with large vessel stroke were younger than 50 years and without previous stroke risk factors. In this study, consistent with other case series, patients with COVID-19 fare worse in terms of clinical outcomes than patients with stroke who do not have COVID-19.…”

Ischaemic stroke as the presenting feature of COVID-19: a series of three cases from Qatar

“…This partly reflects the demographics of Qatar; nearly 90% of the population are foreign workers and the median age of the population is 32 years [ 7 ]. Nevertheless, other countries are recognizing that younger patients with COVID-19 can suffer strokes [ 8 , 9 ].…”