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. 2020 Sep;51(9):e227-e231.
doi: 10.1161/STROKEAHA.120.031265. Epub 2020 Aug 6.

Cerebrovascular Complications of COVID-19

Jeffrey M Katz  1   2 , Richard B Libman  1 , Jason J Wang  3 , Pina Sanelli  2 , Christopher G Filippi  2 , Michele Gribko  1 , Steven V Pacia  1 , Ruben I Kuzniecky  1 , Souhel Najjar  1 , Salman Azhar  1
Affiliations

Cerebrovascular Complications of COVID-19

Jeffrey M Katz et al. Stroke. 2020 Sep.

Abstract

Background and purpose: Coronavirus disease 2019 (COVID-19) evolved quickly into a global pandemic with myriad systemic complications, including stroke. We report the largest case series to date of cerebrovascular complications of COVID-19 and compare with stroke patients without infection.

Methods: Retrospective case series of COVID-19 patients with imaging-confirmed stroke, treated at 11 hospitals in New York, between March 14 and April 26, 2020. Demographic, clinical, laboratory, imaging, and outcome data were collected, and cases were compared with date-matched controls without COVID-19 from 1 year prior.

Results: Eighty-six COVID-19-positive stroke cases were identified (mean age, 67.4 years; 44.2% women). Ischemic stroke (83.7%) and nonfocal neurological presentations (67.4%) predominated, commonly involving multivascular distributions (45.8%) with associated hemorrhage (20.8%). Compared with controls (n=499), COVID-19 was associated with in-hospital stroke onset (47.7% versus 5.0%; P<0.001), mortality (29.1% versus 9.0%; P<0.001), and Black/multiracial race (58.1% versus 36.9%; P=0.001). COVID-19 was the strongest independent risk factor for in-hospital stroke (odds ratio, 20.9 [95% CI, 10.4-42.2]; P<0.001), whereas COVID-19, older age, and intracranial hemorrhage independently predicted mortality.

Conclusions: COVID-19 is an independent risk factor for stroke in hospitalized patients and mortality, and stroke presentations are frequently atypical.

Keywords: cerebrovascular disorders; demography; odds ratio; pandemics; risk factors.

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Conflict of interest statement

None.

Figures

Figure.
Figure.
Coronavirus disease 2019 (COVID-19)–associated large vessel occlusion. A, Angiogram displaying distal basilar artery occlusion (black arrow) in a 54-y-old man. B, Post-thrombectomy, magnetic resonance imaging diffusion shows right inferior cerebellar and paramedian pontine infarctions. C, Computed tomography (CT) head showing bilateral middle cerebral artery infarctions in a 62-y-old woman with. D, CT angiogram demonstrating occlusions of proximal left middle cerebral artery (white arrows) and terminal right internal carotid artery and middle cerebral artery (black arrow).
See this image and copyright information in PMC

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