Analysis of the clinical manifestations of cerebral stroke in patients with the novel coronavirus infection (COVID-19)

Abstract

Objective: To improve the diagnosis and treatment of acute cerebrovascular accident in patients with community-acquired pneumonia caused by the novel coronavirus infection (COVID-19). Materials and methods: For the first time, clinical manifestations of strokes in patients with diagnosed new coronavirus infection (COVID-19) were analyzed in 130 patients. The study was conducted in two groups. The main group consisted of 69,2 % (n = 90) with a clinical and instrumental diagnosis: novel coronavirus infection in combination with stroke. The control group (30,8 %; n = 40) included the cases of ischemic and hemorrhagic stroke without signs of SARS-CoV-2. In both groups, the severity of the disease and pathogenetic subtypes were compared, and the features of the laboratory biochemical data were studied. Statistical analysis of the outcomes was carried out taking into account the severity of brain and lung tissue damage. Results: In patients with cerebral stroke against the background of the new coronavirus infection (COVID-19), the prevalence of ischemic stroke cases (86,4 %) was noted for undetermined (41,4 %) and cardioembolic (35,7 %) pathogenetic subtypes (according to TOAST) with localization in the carotid basin (89,7 %). In hemorrhagic stroke, parenchymal hemorrhage was observed with a greater frequency (54,5 %). The severity of the diagnosed strokes according to the NIHSS scale was up to 13,16 (8,80) points with less severe brain damage — Glasgow coma scale (14,0 (12,0 15,0). In the group of the patients, a widespread lesion of the lung tissue was diagnosed in 82,2 % of cases. No significant increase in the incidence of clinically significant manifestations of systemic and organ hypercoagulation was established. Conclusions: In stroke patients with COVID-19, ischemic manifestations with undetermined and cardioembolic subtypes without age and gender features prevail, with no differences in the severity of the course and a large number of favorable outcomes. A high activity of inflammatory and infectious changes was established by clinical laboratory.