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Cerebrovascular Complications of COVID-19
Jeffrey M Katz1,2, Richard B Libman1, Jason J Wang3
1Departments of Neurology (J.M.K., R.B.L., M.G., S.V.P., R.I.K., S.N., S.A.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
Insights
Coronavirus disease 2019 (COVID-19) significantly increases the risk of stroke in hospitalized patients. This study found COVID-19 to be the strongest predictor of in-hospital stroke and mortality, with often atypical presentations.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Coronavirus disease 2019 (COVID-19) rapidly became a global pandemic, causing diverse systemic complications, notably stroke.
- Cerebrovascular complications represent a significant concern in COVID-19 patients.
Purpose of the Study:
- To report the largest case series of cerebrovascular complications in COVID-19 patients.
- To compare stroke characteristics and outcomes in COVID-19 patients versus non-infected individuals.
Main Methods:
- A retrospective case series of 86 COVID-19 patients with confirmed stroke across 11 New York hospitals (March-April 2020).
- Collected demographic, clinical, laboratory, imaging, and outcome data.
- Compared COVID-19 stroke cases with 499 date-matched controls without COVID-19 from the prior year.
Main Results:
- COVID-19 patients experienced higher rates of in-hospital stroke onset (47.7% vs 5.0%) and mortality (29.1% vs 9.0%) compared to controls.
- COVID-19 was the strongest independent risk factor for in-hospital stroke (OR, 20.9).
- Ischemic stroke predominated (83.7%), often with atypical, nonfocal neurological presentations and multivascular involvement.
Conclusions:
- COVID-19 is an independent risk factor for stroke in hospitalized patients.
- COVID-19 is also an independent predictor of mortality in stroke patients.
- Stroke presentations in COVID-19 patients are frequently atypical.
Background And Purpose:
Coronavirus disease 2019 (COVID-19) evolved quickly into a global pandemic with myriad systemic complications, including stroke. We report the largest case series to date of cerebrovascular complications of COVID-19 and compare with stroke patients without infection.
Methods:
Retrospective case series of COVID-19 patients with imaging-confirmed stroke, treated at 11 hospitals in New York, between March 14 and April 26, 2020. Demographic, clinical, laboratory, imaging, and outcome data were collected, and cases were compared with date-matched controls without COVID-19 from 1 year prior.
Results:
Eighty-six COVID-19-positive stroke cases were identified (mean age, 67.4 years; 44.2% women). Ischemic stroke (83.7%) and nonfocal neurological presentations (67.4%) predominated, commonly involving multivascular distributions (45.8%) with associated hemorrhage (20.8%). Compared with controls (n=499), COVID-19 was associated with in-hospital stroke onset (47.7% versus 5.0%; P<0.001), mortality (29.1% versus 9.0%; P<0.001), and Black/multiracial race (58.1% versus 36.9%; P=0.001). COVID-19 was the strongest independent risk factor for in-hospital stroke (odds ratio, 20.9 [95% CI, 10.4-42.2]; P<0.001), whereas COVID-19, older age, and intracranial hemorrhage independently predicted mortality.
Conclusions:
COVID-19 is an independent risk factor for stroke in hospitalized patients and mortality, and stroke presentations are frequently atypical.
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