Stroke in COVID-19: A Single-Center Initial Experience in a Hotspot of the Pandemic

Abstract

Background: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global pandemic that has been an immense burden on the healthcare systems all over the world. Studies have shown that these patients may be at higher risk for acute ischemic stroke (AIS). We present our initial experience with AIS in patients with COVID-19. Methods: We reviewed all patients admitted to our hospital during a 6-week period with a positive nasopharyngeal swab test for SARS-CoV-2. Among these patients, we identified AIS by chart review. We reviewed the demographics, clinical, laboratory, imaging characteristics, treatments received, and outcomes of AIS in COVID-19 patients. Results: We identified 683 patients admitted with COVID-19 during the study period, of which 20 patients had AIS. Large vessel occlusion (LVO) was noted in 11 patients (55%). Intravenous alteplase (IV tPA) was administered in four patients (20%) and mechanical thrombectomy (MT) was performed in five patients (25%). More than half of the patients were out of window for IV tPA. Respiratory symptoms preceded the onset of stroke in most of the patients (70%), ranging between one to 21 days. The mortality in patients with AIS was 50% compared to 26% of all COVID-19 admissions. Most of these patients died due to non-neurological causes (70%). There were three patients with AIS, who had clinical, laboratory, and imaging findings consistent with COVID-19, but were negative for multiple nasopharyngeal swab tests. Interpretation: LVO was more common in patients with AIS and COVID-19. They had more severe disease and higher mortality rates. Most of the patients had respiratory symptoms preceding AIS by days to weeks. This could explain certain patients with clinical picture of COVID-19 but negative nasopharyngeal swab tests. We need larger studies to further understand the association and mechanisms of AIS in COVID-19. Funding Statement: None. Declaration of Interests: All authors have stated that they have no conflicts of interest. Ethics Approval Statement: This study was approved by the institutional review board of Rutgers University.