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Acute stroke in COVID-19 patients: A first year experience in a Colombian hospital

N Cerón Blanco1, C A Romero Hernández2, J Vallejo Fernández3

  • 1Residente de Neurología, Universidad del Rosario, Fundación, Cardioinfantil, Colombia.

Neurology Perspectives
|June 12, 2023
PubMed

Insights

COVID-19 is a risk factor for stroke, with over 4% of stroke patients testing positive for SARS-CoV-2. These patients often experience severe COVID-19 and unfavorable stroke outcomes, highlighting hypercoagulation as a potential cause.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiovascular Research

Background:

  • COVID-19 (Coronavirus Disease 2019) is increasingly recognized as a potential risk factor for cerebrovascular events, including stroke.
  • Stroke incidence in COVID-19 patients ranges from 1.1% to 8.1%, linked to various pathophysiological mechanisms associated with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection.

Purpose of the Study:

  • To characterize patients diagnosed with acute stroke concurrently with COVID-19 infection at a single Colombian medical center.
  • To analyze the demographic, clinical, and etiological features of stroke in the context of SARS-CoV-2 infection.

Main Methods:

  • A retrospective review of medical records was conducted for patients admitted with acute stroke and a positive PCR (Polymerase Chain Reaction) test for SARS-CoV-2 between March 2020 and March 2021.
  • Data collected included patient demographics, stroke characteristics, COVID-19 severity, inflammatory biomarkers, treatment received, and clinical outcomes.
  • Descriptive statistics were used to summarize the findings, presenting continuous variables as means and ranges, and categorical variables as frequencies and percentages.

Main Results:

  • Out of 328 acute stroke patients, 14 (4.2%) tested positive for SARS-CoV-2. The mean age was 56.4 years, with 57% males.
  • Eleven patients (78.5%) were diagnosed with ischemic stroke, primarily affecting the anterior circulation. Elevated inflammatory markers (D-dimer, ferritin, LDH) were present in all patients.
  • A significant proportion (85.7%) had severe COVID-19, with 64.3% experiencing unfavorable outcomes (modified Rankin Scale > 2), and an in-hospital case fatality rate of 14.2%.

Conclusions:

  • COVID-19 infection can predispose susceptible individuals to stroke, potentially mediated by hypercoagulation and immune-related thrombosis.
  • The clinical profile and outcomes of COVID-19-associated stroke patients in Colombia align with international observations.
  • Prompt recognition and management of stroke in COVID-19 patients are crucial, considering the high rates of severe disease and adverse neurological outcomes.
Abstract

Keywords:
COVID-19SARS-CoV-2StrokeTIAbrain infarct

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