Ischemic Stroke in COVID-19: An Urgent Need for Early Identification and Management
Abstract
Objective
In the setting of the Coronavirus Disease 2019 (COVID-19) global pandemic caused by SARS-CoV-2, a potential association of this disease with stroke has been suggested. We aimed to describe the characteristics of patients who were admitted with COVID-19 and had an acute ischemic stroke (AIS).
Methods
This is a case series of PCR-confirmed COVID-19 patients with ischemic stroke admitted to an academic health system in metropolitan Atlanta (USA) between March 24th,2020, and May 5th, 2020. Demographic, clinical, and radiographic characteristics were described.
Results
Of 124 ischemic stroke patients admitted during this study period, 8 (6.5%) were also diagnosed with COVID-19. The mean age of patients was 64.3 ± 6.5 years, 5 (62.5%) male, mean time from last-normal was 4.8 days [SD 4.8], and none received acute reperfusion therapy. All 8 patients had at least one stroke-associated co-morbidity. The predominant pattern of ischemic stroke was embolic; 3 were explained by atrial fibrillation while 5 (62.5%) were cryptogenic. In contrast, cryptogenic strokes were seen in 20 (16.1%) of 124 total stroke admissions during this time.
Conclusions
In our case series, ischemic stroke affected COVID-19 patients with traditional stroke risk factors with an age of stroke presentation typically seen in non-COVID populations. We observed a predominantly embolic pattern of stroke with a higher than expected rate of cryptogenic strokes and with a prolonged median time to presentation and symptom recognition limiting the use of acute reperfusion treatments. These results highlight the need for increased community awareness, early identification, and management of AIS in COVID-19 patients.
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