Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19

Abstract

Background Coronavirus disease 2019 (COVID-19) is an infection which can affect the central nervous system. In this study, we sought to investigate associations between neuroimaging findings with clinical, demographic, blood and cerebrospinal fluid (CSF) parameters, pre-existing conditions and the severity of acute COVID-19. Materials and methods Retrospective multicenter data retrieval from 10 university medical centers in Germany, Switzerland and Austria between February 2020 and September 2021. We included patients with COVID-19, acute neurological symptoms and cranial imaging. We collected demographics, neurological symptoms, COVID-19 severity, results of cranial imaging, blood and CSF parameters during the hospital stay. Results 442 patients could be included. COVID-19 severity was mild in 124 (28.1%) patients (moderate n = 134/30.3%, severe n = 43/9.7%, critical n = 141/31.9%). 220 patients (49.8%) presented with respiratory symptoms, 167 (37.8%) presented with neurological symptoms first. Acute ischemic stroke (AIS) was detected in 70 (15.8%), intracranial hemorrhage (IH) in 48 (10.9%) patients. Typical risk factors were associated with AIS; extracorporeal membrane oxygenation therapy and invasive ventilation with IH. No association was found between the severity of COVID-19 or blood/CSF parameters and the occurrence of AIS or IH. Discussion AIS was the most common finding on cranial imaging. IH was more prevalent than expected but a less common finding than AIS. Patients with IH had a distinct clinical profile compared to patients with AIS. There was no association between AIS or IH and the severity of COVID-19. A considerable proportion of patients presented with neurological symptoms first. Laboratory parameters have limited value as a screening tool.

Effects of COVID-19 on cognition and brain health

“…MRI scans on COVID-19 patients who showed cognitive deficits or neurological symptoms indicated a high prevalence of cerebrovascular abnormalities, including ischaemic strokes, intracranial haemorrhage, and cerebral microbleeds, which could contribute to cognitive deficits [ 68 , 69 , 72 , 93. , 94. , 95.…”

History of cerebrovascular disease but not dementia increases the risk for secondary vascular events during SARS‐CoV‐2 infection with presumed Omicron variant: a retrospective observational study

“…Although CeVD patients did not show increased mortality or risk for ICU admission, they were significantly more likely to experience a secondary cerebrovascular event or pulmonary artery embolism. The pathophysiology of these vascular events in patients with SARS‐CoV‐2 infections has already been introduced and includes endothelial dysfunction, a hyperactive immune response and a procoagulatory state [19]. Current literature suggests that patients with SARS‐CoV‐2 variants other than Omicron have an increased risk for cerebrovascular events during the acute infection and this risk stays elevated for at least 1 month [20].…”

“…Since especially older patients with Omicron infection are at risk of being admitted to the hospital [4], neurological preconditions such as stroke and dementia that have a higher prevalence at older ages are commonly present in hospitalized patients with Omicron infection. It is therefore crucial to understand the impact of specific comorbidities versus general factors such as age and number of comorbidities on the course of coronavirus disease 2019 (COVID- 19).…”