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Published on: May 22, 2019
COVID-19 presenting as stroke
Akshay Avula1, Krishna Nalleballe2, Naureen Narula1
1Department of Pulmonary Critical Care Medicine, Northwell Health - Staten Island University Hospital, NY, United States.
Insights
Patients with COVID-19 (coronavirus disease 2019) can experience acute stroke as an initial symptom. This study highlights four such cases, emphasizing the need for vigilance in diagnosing neurological complications during the pandemic.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Acute stroke is a critical medical emergency, even amidst the COVID-19 pandemic.
- COVID-19 (coronavirus disease 2019) often presents with respiratory symptoms but can manifest atypically, including neurological issues.
Observation:
- This case series details four patients who presented with acute stroke and were diagnosed with COVID-19.
- The study reviewed clinical characteristics, imaging findings, and patient outcomes.
Findings:
- All four patients had radiographic evidence of stroke and confirmed SARS-CoV-2 infection.
- The findings underscore the potential for cerebrovascular accidents as an early or presenting sign of COVID-19.
Implications:
- Healthcare providers must consider stroke in COVID-19 patients presenting with non-respiratory symptoms.
- Prompt recognition and hyperacute stroke treatment are crucial for improving outcomes.
- Further research is needed to understand the link between COVID-19 and neurological pathology.
Objective:
Acute stroke remains a medical emergency even during the COVID-19 pandemic. Most patients with COVID-19 infection present with constitutional and respiratory symptoms; while others present with atypical gastrointestinal, cardiovascular, or neurological manifestations. Here we present a series of four patients with COVID-19 that presented with acute stroke.
Methods:
We searched the hospital databases for patients that presented with acute stroke and concomitant features of suspected COVID-19 infection. All patients who had radiographic evidence of stroke and PCR-confirmed COVID-19 infection were included in the study. Patients admitted to the hospital with PCR- confirmed COVID-19 disease whose hospital course was complicated with acute stroke while inpatient were excluded from the study. Retrospective patient data were obtained from electronic medical records. Informed consent was obtained.
Results:
We identified four patients who presented with radiographic confirmation of acute stroke and PCR-confirmed SARS-CoV-2 infection. We elucidate the clinical characteristics, imaging findings, and the clinical course.
Conclusions:
Timely assessment and hyperacute treatment is the key to minimize mortality and morbidity of patients with acute stroke. Stroke teams should be wary of the fact that COVID-19 patients can present with cerebrovascular accidents and should dawn appropriate personal protective equipment in every suspected patient. Further studies are urgently needed to improve current understandings of neurological pathology in the setting of COVID-19 infection.
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