Timing of Acute Stroke in COVID-19—A Health System Registry Study

Ibrahim Migdady, Aaron Shoskes, Leen Z. Hasan, Catherine Hassett, Pravin George, Christopher Newey, Sung Min Cho, Alexander Rae-Grant, Ken Uchino

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose: The association between SARS-CoV-2 infection and stroke remains unknown. We aimed to compare the characteristics of stroke patients who were hospitalized with Coronavirus Disease 2019 (COVID-19) based on the timing of stroke diagnosis. Methods: We performed a retrospective analysis of adult patients in a health system registry of COVID-19 who were hospitalized and had imaging-confirmed acute stroke during hospitalization. Baseline characteristics and hospital outcomes were collected and analyzed. Results: Out of 882 COVID-19 patients who were hospitalized between March 9 to May 17, 2020, 14 patients (2% of all COVID-19 patients and 21% of those who underwent imaging) presented with stroke or developed stroke during hospitalization. Eleven had acute ischemic stroke (AIS) and 3 had acute hemorrhagic stroke. Six patients (43%) presented to the hospital with acute stroke symptoms and were found to have SARS-CoV-2. Compared to patients who presented with AIS, more patients with AIS during hospitalization were male, of older age, had pneumonia and acute respiratory distress syndrome, were severely ill, and had high inflammatory and thrombotic markers (including C reactive protein, D dimer, ferritin, and fibrinogen). Among all patients, hospital mortality was high (50%) and the majority of patients who were discharged had poor neurological outcome. Conclusions: A distinction should be made between patients who present with acute stroke with concurrent SARS-CoV-2 infection and those who develop stroke as a complication of severe COVID-19. It is likely that a subset of stroke patients will incidentally test positive for the virus given the widespread pandemic.

Original languageEnglish (US)
Pages (from-to)285-294
Number of pages10
JournalNeurohospitalist
Volume11
Issue number4
DOIs
StatePublished - Oct 2021
Externally publishedYes

Keywords

  • COVID-19
  • hemorrhagic stroke
  • ischemic stroke
  • SARS-CoV-2

ASJC Scopus subject areas

  • Clinical Neurology

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