Stroke in COVID-19: A systematic review and meta-analysis

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• The COVID-19 pandemic has raised concerns about its impact on neurological health.
• The precise relationship between COVID-19 infection and acute cerebrovascular diseases remains unclear.

Purpose of the Study:

• To investigate the incidence, risk factors, clinical and radiological features, and outcomes of stroke in patients with COVID-19.
• To characterize the cerebrovascular disease burden associated with SARS-CoV-2 infection.

Main Methods:

• A systematic review and meta-analysis of published studies on acute cerebrovascular diseases in COVID-19 patients.
• Data extraction from articles reporting at least five stroke cases in COVID-19 patients, adhering to PRISMA guidelines.
• Quality assessment using the Newcastle-Ottawa Scale and data pooling via a random-effect model.

Main Results:

• 1.4% of 108,571 COVID-19 patients experienced acute cerebrovascular diseases, primarily ischemic stroke (87.4%).
• COVID-19 patients with stroke were older, more likely to have hypertension, diabetes, coronary artery disease, and severe infection compared to non-stroke COVID-19 patients.
• COVID-19 patients with stroke presented younger, with higher NIHSS scores, more large vessel occlusions, and increased in-hospital mortality compared to stroke patients without COVID-19.

Conclusions:

• Acute cerebrovascular diseases are a significant concern in COVID-19 patients, particularly those with severe infections and vascular risk factors.
• The findings suggest cerebral thrombosis and/or thromboembolism as potential mechanisms, indicated by patterns of large vessel occlusion and multi-territory infarcts.