Radiologic and Clinical Characteristics of Stroke Patients with Covid-19: A Case-Control Study

A severe infection such as COVID-19 may trigger a stroke. The imaging and clinical features of patients with COVID-19 are not well-defined. We aimed to analyze neuroimaging and clinical features of stroke patients with COVID-19.

The demographic and clinical data of 21 stroke cases with confirmed COVID-19 (StrokeCov) between April 2020-May 2021 were collected prospectively. An experienced stroke neurologist evaluated neuroimaging findings. A control group of gender, age, and risk factors adjusted 104 stroke patients were included.

Mean age was 66.3 (±13.3) and 66.2 (±13) years in the StrokeCov group and control group (CG), with similar male-to-female ratios (85%) and without significant difference regarding diabetes, hypertension, hyperlipidemia, and atrial fibrillation between groups (p>0.05). Infarcts were most frequently seen in the territory of middle cerebral artery (8 patients; 40%), followed by multiple arterial territories (6 patients; 30%). Ischemic lesions were more frequently localized in both anterior and posterior vascular systems in StrokeCov group (3 patients; 15%) in comparison to CG (2 patients; 2%; p=0.02). Although, hemorrhagic transformation was observed more frequently in StrokeCov group (6 patients; 30%) than CG (11 patients; 10%; p=0.02); statistically significant difference was not seen in terms of acute and preventive treatments given to both groups. The mRS scores on discharge were worse in the StrokeCov group (p<0.00).

Ischemic stroke lesions in StrokeCov group are more likely to be localized on multiple arterial territories and develop hemorrhagic transformation. Poor clinical outcome and in-hospital death are more common in stroke due to COVID-19.