Acute Cerebrovascular Events With COVID-19 Infection

Mandip S. Dhamoon, Alison Thaler, Kapil Gururangan, Amit Kohli, Daniella Sisniega, Danielle Wheelwright, Connor Mensching, Johanna T. Fifi, Michael G. Fara, Nathalie Jette, Ella Cohen, Priya Dave, Aislyn C. DiRisio, Jonathan Goldstein, Emma M. Loebel, Naomi A. Mayman, Akarsh Sharma, Daniel S. Thomas, Ruben D. Vega Perez, Mark R. Weingarten, Huei Hsun Wen, Stanley Tuhrim, Laura K. Stein, Mount Sinai Stroke Investigators

Abstract

Background and Purpose: Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known.

Methods: We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results.

Results: Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, P<0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal (P=0.02), parietal (P=0.002), occipital (P=0.002), and cerebellar (P=0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay (P<0.0001), greater percentage requiring intensive care unit care (P=0.017), and greater rate of neurological worsening during admission (P<0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, P<0.0001).

Conclusions: Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.

Keywords: epidemiology; incidence; intracerebral hemorrhage; ischemic stroke; length of stay; risk factors; subarachnoid hemorrhage.

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