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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Timing of Acute Stroke in COVID-19-A Health System Registry Study
Ibrahim Migdady1,2, Aaron Shoskes1, Leen Z Hasan3,4
1Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
Insights
Stroke patients hospitalized with COVID-19 (Coronavirus Disease 2019) showed higher mortality and poor neurological outcomes. Stroke developing during hospitalization indicated more severe illness and higher inflammatory markers compared to those presenting with stroke and SARS-CoV-2 infection.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- The relationship between SARS-CoV-2 infection and stroke is not well understood.
- Distinguishing stroke presentation in COVID-19 patients is crucial for management.
Purpose of the Study:
- To compare characteristics of stroke patients hospitalized with COVID-19.
- To analyze stroke timing relative to COVID-19 diagnosis.
Main Methods:
- Retrospective analysis of adult patients with COVID-19 and imaging-confirmed acute stroke.
- Collected baseline characteristics and hospital outcomes.
Main Results:
- 14 of 882 COVID-19 patients had stroke (2%); 11 ischemic, 3 hemorrhagic.
- Patients with stroke during hospitalization were older, male, had more severe COVID-19, pneumonia, ARDS, and higher inflammatory/thrombotic markers.
- Hospital mortality was 50%, with most discharged patients having poor neurological outcomes.
Conclusions:
- Differentiate between stroke presenting with SARS-CoV-2 and stroke as a complication of severe COVID-19.
- Incidental SARS-CoV-2 positivity in stroke patients is probable during the pandemic.
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.
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