Acute Cerebrovascular Events With COVID-19 Infection

Abstract

Background and Purpose: Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known. Methods: We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results. Results: Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, P <0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal ( P =0.02), parietal ( P =0.002), occipital ( P =0.002), and cerebellar ( P =0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay ( P <0.0001), greater percentage requiring intensive care unit care ( P =0.017), and greater rate of neurological worsening during admission ( P <0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, P <0.0001). Conclusions: Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.

The emerging association between COVID-19 and acute stroke

“…In our retrospective series, 1.9% (n = 105) of the 5469 COVID-19 patients admitted to our health system during March and April were diagnosed with stroke [49]. The majority of COVID-19 positive stroke patients suffered ischemic stroke (79.1%) followed by 15.2% intracerebral hemorrhage, 3.8% subarachnoid hemorrhage, and 1.9% transient ischemic attack.…”

Delayed manifestation of extensive COVID-19-associated coagulopathy in high-risk patient

“…The fact that patient has recovered near fully from neurological standpoint also supports vascular inflammation-related event rather than underlying cardiac issues. [7][8][9] Of note, patient did have a venous catheter in place in the right cavoatrial junction at the time of developing the jugular vein thrombi; however, it does not explain why she would develop bilateral thrombosis. Of note, CT angiography of the neck was attempted but was a poor study, hence, could not determine if there was clot propagation from one side of the neck to the other.…”

A Case of Bilateral Thalamic Infarcts Involving the Artery of Percheron in the Setting of COVID-19

“…Ischemic stroke is a rare but known manifestation of COVID-19 [6]. One large retrospective study shows that the incidence of the stroke in COVID-19 patients is slightly more than 1%, but cannot be ignored [7].…”

“…Recent studies have demonstrated that patients who are COVID-19 positive were more likely to have a cryptogenic cause of stroke when compared to COVID-19 negative patients, suggesting an association of COVID-19 disease with stroke [6,7]. This association of COVID-19 disease with acute ischemic stroke is likely secondary to multiple factors as SARS CoV-2 has been postulated to cause endothelial damage, severe cytokine release, generalized hypercoagulability, as well as direct cytopathic effect on the central nervous system [6][7][8]. Hypercoagulability is one of the features of pathogenesis of COVID-19 disease [8].…”

“…Respiratory and gastrointestinal systems are commonly affected by this infection. Neurological manifestations such as acute ischemic stroke associated with a hypercoagulable state caused by COVID-19 are increasingly being reported [6]. In this case report, we present a unique case of AOP infarction presenting as transient loss of consciousness, intermittent anisocoria, dysarthria, and right-sided weakness in the setting of COVID-19 infection.…”