Stroke as a presenting symptom of COVID-19; A study of risk factors, characteristics and outcomes in a sample of Egyptian patients

Abstract

Background; It is not known whether COVID-19 associated stroke patients have worse functional and vital outcomes than those without infection. Aim and objectives; To compare between COVID-19 associated stroke and non-COVID-19 stroke patients as regard risk factors, characters and outcome. Patients and methods; In a prospective study, 297 patients diagnosed clinically and radiologically as stroke and admitted to emergency department and stroke unit of Al- Azhar University hospitals were recruited in the period from beginning of December, 2021 to the end of May, 2022. They were classified into ischemic stroke (IS), Cerebral venous thrombosis (CVT), Subarachnoid hemorrhage (SAH), and Intracerebral hemorrhage (ICH) groups. Workup for COVID-19 was done in each group followed by comparison between both groups. Results: We evaluated 297 patients and 46 (15.4%) had COVID-19 infection. In IS group, Age, HTN and previous cerebrovascular stroke were significantly lower, large vessel occlusion, Median baseline National Institutes of Health Stroke Scale score (NIHSS) and serum ferritin were significantly higher, in COVID-19 associated IS group. Also, COVID-19 associated IS had a worse outcome regarding Median Modified Rankin Scale (MRS), hemorrhagic transformation and mortality rate. According to TOAST classification, cryptogenic subtype was significantly higher in COVID-19 associated IS group. Lymphocytes (%) was significantly lower, D-dimer was significantly higher, in COVID-19 patients in all stroke groups. Conclusion: Patients with COVID-19 associated ischemic stroke have more severe strokes, worse functional outcome and a higher mortality than those without infection.