A "Post-mortem" of COVID-19-associated stroke: a case-control study

Abstract

Objectives: To assess whether COVID-19 could be a concurrent factor in the genesis and/or worsening of stroke and to provide data on COVID-19 -associated stroke patients during the first pandemic wave and comparative data on COVID-19 negative stroke patients in the same period.

Materials and methods: This is a retrospective, observational, case-control, single centre study, carried out in a General Hospital in northern Italy. Sixty-three consecutive stroke patients were included, COVID-19-associated stroke was classified as cases and non COVID-19-associated stroke as controls.

Results: A total of 19/63 (28.8%) had a COVID-19-associated stroke, 11 /63 (17.5%) were haemorrhagic and 52/63 (82.5%) ischaemic. COVID-19-associated strokes were more severe (p-value 0.019) and had a higher risk of severe disability and/or death (OR 3.79, CI 95%: 1.21-11.93, p-value 0.19). The COVID-19-associated stroke patients with onset during hospitalization for COVID-19 had a more severe stroke than patients with COVID-19 onset during hospitalization for stroke (p-value 0.019).

Conclusion: Although no relationship was observed between the stroke aetiology and COVID-19, intriguingly, COVID-associated stroke turned out to be more severe and disabling. Hopefully, further studies will provide more data and help in the management of this emerging population.

Keywords: COVID-19; COVID-19-associated stroke; Case-control study; Large vessel occlusion; SARS-CoV-2.

Fig. 1

A Computed Tomography Angiography (CTA) of a 65-year-old male, COVID-19-associated stroke patient, with left hemiparesis and neglect (NIHSS 18) after having had a temperature, cough and dyspnea for 7 days. The arterial phase of the CTA evidences a steno-occlusion of right middle cerebral artery (arrow) (A: maximum intensity projection; B: volume rendering technique with top view). A head Computed Tomography scan (CT), performed 24 hrs. later, documented an extensive ischaemic lesion in the right temporal and frontal lobes (C). A chest CT scan, on the 2nd day after admission, for respiratory symptoms, evidenced a bilateral reticular pattern, superimposed on a background of ground-glass opacities (GGO) (D-F) and bibasilar subpleural consolidations (F). Fibrous stripes and multiple small vascular enlargement were also observed (E and F). Well aerated lung with a visual score of 40%.