Ischemic stroke in COVID-19: An urgent need for early identification and management

• Published in: PloS one 2020-09, Vol.15 (9), p.e0239443-e0239443
• Main Authors: Jillella, Dinesh V, Janocko, Nicholas J, Nahab, Fadi, Benameur, Karima, Greene, James G, Wright, Wendy L, Obideen, Mahmoud, Rangaraju, Srikant
• Format: Article
• Language: English
• Subjects: African Americans; Aged; Atrial Fibrillation - complications; Betacoronavirus; Biology and Life Sciences; Brain Ischemia - ethnology; Brain Ischemia - etiology; Brain Ischemia - virology; Cardiac arrhythmia; Comorbidity; Complications and side effects; Coronavirus Infections - complications; Coronavirus Infections - ethnology; Coronaviruses; COVID-19; Disease Management; Early Diagnosis; Embolism - complications; Etiology; Female; Fibrillation; Health risks; Humans; Hypertension; Infections; Ischemia; Male; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Morbidity; Neurology; Pandemics; Patients; Pneumonia, Viral - complications; Pneumonia, Viral - ethnology; Preventive medicine; Pulmonary embolisms; Reperfusion; Research and Analysis Methods; Risk analysis; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Stroke; Stroke - ethnology; Stroke - etiology; Stroke - virology; Supervision; Thrombosis; Veins & arteries; Viral diseases
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0239443

In the setting of the Coronavirus Disease 2019 (COVID-19) global pandemic caused by SARS-CoV-2, a potential association of this disease with stroke has been suggested. We aimed to describe the characteristics of patients who were admitted with COVID-19 and had an acute ischemic stroke (AIS). This is a case series of PCR-confirmed COVID-19 patients with ischemic stroke admitted to an academic health system in metropolitan Atlanta, Georgia (USA) between March 24th, 2020 and July 17th, 2020. Demographic, clinical, and radiographic characteristics were described. Of 396 ischemic stroke patients admitted during this study period, 13 (2.5%) were also diagnosed with COVID-19. The mean age of patients was 61.6 ± 10.8 years, 10 (76.9%) male, 8 (61.5%) were Black Americans, mean time from last normal was 4.97 ± 5.1 days, and only one received acute reperfusion therapy. All 13 patients had at least one stroke-associated co-morbidity. The predominant pattern of ischemic stroke was embolic with 4 explained by atrial fibrillation. COVID-19 patients had a significantly higher rate of cryptogenic stroke than non-COVID-19 patients during the study period (69% vs 17%, p = 0.0001). In our case series, ischemic stroke affected COVID-19 patients with traditional stroke risk factors at an age typically seen in non-COVID populations, and mainly affecting males and Black Americans. We observed a predominantly embolic pattern of stroke with a higher than expected rate of cryptogenic strokes, a prolonged median time to presentation and symptom recognition limiting the use of acute reperfusion treatments. These results highlight the need for increased community awareness, early identification, and management of AIS in COVID-19 patients.