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Time of Stroke Onset in Coronavirus Disease 2019 Patients Around the Globe: A Systematic Review and Analysis
Natalia Valencia-Enciso1, Mónica Ortiz-Pereira1, María Paula Zafra-Sierra1
1Universidad de los Andes, Cra 1 N° 18A - 12, Bogotá 111711, Colombia.
Insights
The severity of Coronavirus disease 2019 (COVID-19) correlates with the timing of stroke onset. Younger patients with severe COVID-19 and stroke experienced large vessel occlusion, suggesting hypercoagulability as a potential cause.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiovascular Research
Background:
- Coronavirus disease 2019 (COVID-19) is linked to stroke, but patient characteristics and stroke etiology require further understanding.
- Effective management of COVID-19 patients experiencing stroke necessitates a clear grasp of symptom onset timing, clinical presentation, and underlying causes.
- A potential temporal relationship between COVID-19 severity and stroke onset is hypothesized.
Purpose of the Study:
- To investigate the relationship between COVID-19 severity and stroke onset.
- To analyze clinical, sociodemographic, and laboratory features of patients with COVID-19 and stroke.
- To explore potential etiological factors, including hypercoagulability, in COVID-19-associated strokes.
Main Methods:
- A systematic literature review was performed using PubMed and Scopus databases.
- Studies reporting patients with both COVID-19 and stroke were included.
- Data extraction and analysis focused on clinical, sociodemographic, and laboratory characteristics.
Main Results:
- 176 patients from 47 studies were analyzed; the mean age was 63.1 years, with 63.2% males.
- Cryptogenic stroke was the most frequent etiology (40.9%). Large vessel occlusion occurred in 65.9% of patients, who were younger and had greater stroke severity.
- Elevated inflammatory and hypercoagulability markers (D-dimer, C-reactive protein, fibrinogen, ferritin, LDH) were common. Mean time from respiratory symptom onset to stroke was 9 days.
Conclusions:
- A trend exists between COVID-19 severity and the time to stroke onset.
- Age and stroke severity are associated with large vessel occlusion.
- Elevated inflammation and hypercoagulability markers suggest that SARS-CoV-2-induced hypercoagulability should be considered a potential cause of stroke.
Introduction:
Coronavirus disease 2019 has been associated with stroke, particular characteristics of these patients are not fully understood. The adequate management of these patients depends on the comprehension of factors such as temporality, clinical presentation and etiology. We hypothesize there is an important temporal relationship between COVID-19 severity and stroke onset.
Methods:
a systematic review of the available literature was conducted using Pubmed and Scopus, studies reporting patients with Coronavirus disease 19 and stroke were included. Clinical, sociodemographic and laboratory characteristics of patients were extracted and analyzed.
Results:
Forty-seven studies and 176 patients were included, with a mean age of 63.1 years (SD= 16 n=122), most of them were males (63.2% n=171). The most frequent etiology was cryptogenic 40.9% n=66), and a mean National Institute of Health Stroke Scale of 14.4 points was found (SD= 8.6 n=73). Large vessel occlusion was reported in 65.9% patients (n=91) and these patients were younger with greater stroke severity. D-dimer, C-reactive protein, fibrinogen, ferritin and lactate dehydrogenase were elevated in most patients with reported findings. Most patients had severe Coronavirus disease 2019. The mean time from onset of respiratory symptoms to stroke was 9 days (SD=9.9), the shortest time was noted in those with mild and moderate disease.
Conclusions:
There is a trend between the severity of Coronavirus disease 2019 and time to stroke onset. Also, age and stroke severity were found to be related to the development of large vessel occlusion. Inflammation and hypercoagulability markers are elevated in this disease, we propose to not discard hypercoagulability secondary to severe acute respiratory syndrome-coronavirus-2 as an underlying cause of stroke in these patients.
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