Delayed Acute Ischemic Stroke as a Late Manifestation of Asymptomatic COVID-19: The Silent 'Long Haul' Wave of the Pandemic?

Abstract

Background: Multiple neurological manifestations have been associated with acute Coronavirus disease 2019 (COVID-19) infections, however the late sequelae of COVID-19 are less well described. We describe a series of consecutive young men who present with ischemic stroke in the convalescent phase of asymptomatic COVID-19 infection.Methods: We included consecutive young acute ischemic stroke patients (≤50 years old) with laboratory confirmed COVID-19 infections based on positive SARS-CoV-2 serology, without any respiratory symptoms. We reviewed their clinical course, imaging, and laboratory findings.Findings: Eighteen young male patients, aged 35-50 years old, who were diagnosed with asymptomatic COVID-19 based on positive SARS-CoV-2 serology, presented with acute ischemic stroke from 21 May 2020 to 14 October 2020. The median time from positive serology to stroke was 54·5 days (range 0-130). The median age of the patients was 41 (range 35-50), with a median National Institutes of Health Stroke Scale of five (range 1-25). Ten (55·6%) patients presented with large vessel occlusions, of which 6 patients underwent acute recanalization treatment. Only three patients had a possible cardiac source of embolus. The annual incidence rate ischemic stroke was 2·16 (95% CI 1·36 – 3·48, pInterpretation: Eighteen young patients, with laboratory confirmed COVID-19, presented with acute ischemic strokes in the convalescent period. We report what could be the next wave of complications from the COVID-19 pandemic. Larger prospective studies are needed to identify young patients with cryptogenic stroke who may have had COVID-19 infections.Funding: There was no funding for this study.Declaration of Interests: No authors report any conflict of interest related to this study.Ethics Approval Statement: The study was approved by our institutional ethics review board and a waiver of consent was permitted in view of the observational nature of the study.