Stroke in COVID-19: a single-centre initial experience in a hotspot of the pandemic

Abstract

BackgroundCOVID-19, caused by SARS-CoV-2, is a global pandemic that has been an immense burden on healthcare systems all over the world. These patients may be at higher risk for acute ischaemic stroke (AIS). We present our experience with AIS in patients with COVID-19.MethodsWe reviewed all patients admitted to our hospital during a 6-week period with a positive nasopharyngeal swab test for SARS-CoV-2. Among these patients, we identified AIS. We reviewed the demographics, clinical, laboratory, imaging characteristics, treatments received and outcomes of AIS in patients with COVID-19.ResultsWe identified 683 patients admitted with COVID-19 during the study period, of which 20 patients had AIS. Large-vessel occlusion (LVO) was noted in 11 patients (55%). Intravenous alteplase was administered in four patients (20%) and mechanical thrombectomy was performed in five patients (25%). Respiratory symptoms preceded the onset of AIS in most of the patients (70%) by 1 to 21 days. Mortality in patients with AIS was 50% compared with 26% of all COVID-19 admissions. Most of these patients died due to non-neurological causes (70%). Three patients with AIS had clinical and imaging findings consistent with COVID-19, but were negative for multiple nasopharyngeal swab tests.InterpretationLVO was more common in patients with AIS and COVID-19. They had more severe disease and higher mortality rates. Most of the patients had respiratory symptoms preceding AIS by days to weeks. This could explain certain patients with clinical picture of COVID-19 but negative nasopharyngeal swab tests.

Neurological manifestations of COVID-19 in confirmed and probable cases: A descriptive study from a large tertiary care center

“…Coronavirus disease 2019 (COVID- 19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was recognized as a serious health problem worldwide after the World Health Organization declared it as a pandemic in March 2020. Although COVID-19 was initially considered as a primary potential threat to the respiratory system, it was recognized that many other organ systems could be significantly affected as the pandemic progressed [1,2]. Patients' clinical patterns vary from asymptomatic cases to acute respiratory distress syndrome (ARDS) requiring intensive care and even multiple organ failure resulting in death [3,4].…”

“…Published studies reported that the occurrence of neurological complications in COVID-19 patients was associated with factors such as the severity of infection, age, obesity, metabolic problems, and the presence of comorbid diseases [1,7,8]. The frequency of neurological signs and symptoms was found to be significantly different in various studies [7,9,10].…”

“…Also, the existence of seizure attacks was associated with a high mortality rate.Ó 2021 Elsevier Ltd. All rights reserved.hyposmia and hypogeusia attracted physicians' attention [4,5].Recent studies focusing on neurological involvement have shown an increase in the frequency and variety of neurological findings. Central and peripheral nervous system findings can develop due to direct effects of the virus, para-infectious or post-infectious immune-related diseases, and systemic effects of 5,6].Published studies reported that the occurrence of neurological complications in COVID-19 patients was associated with factors such as the severity of infection, age, obesity, metabolic problems, and the presence of comorbid diseases [1,7,8]. The frequency of neurological signs and symptoms was found to be significantly different in various studies [7,9,10].Pre-existing neurological comorbidities can increase both the frequency and severity of neurological manifestations in patients with COVID-19.…”

Stroke Care during the COVID-19 Pandemic: International Expert Panel Review

“…In a more recent case series of 20 patients with COVID-19 and acute ischemic stroke [ 63 ], mean age was 63 ± 10·7 years (range: 37–78), and all had at least one vascular risk factor and 11 (55%) had LVO. Stroke mechanism was attributed to large artery atherosclerosis in 5 and atrial fibrillation in 2.…”

Endothelial Dysfunction in the Brain

“…Ischemic stroke with multiple cerebral infarctions and of cryptogenic origin is the most frequent type of stroke 11 and mortality among patients with COVID-19 with AIS is as high as 50%. 12 …”