Cerebral ischemic and hemorrhagic complications of coronavirus disease 2019

Int J Stroke. 2020 Oct;15(7):733-742. doi: 10.1177/1747493020937189. Epub 2020 Jun 26.

Abstract

Background: The coronavirus disease 2019 is associated with neurological manifestations including stroke.

Objectives: We present a case series of coronavirus disease 2019 patients from two institutions with acute cerebrovascular pathologies. In addition, we present a pooled analysis of published data on large vessel occlusion in the setting of coronavirus disease 2019 and a concise summary of the pathophysiology of acute cerebrovascular disease in the setting of coronavirus disease 2019.

Methods: A retrospective study across two institutions was conducted between 20 March 2020 and 20 May 2020, for patients developing acute cerebrovascular disease and diagnosed with coronavirus disease 2019. We performed a literature review using the PubMed search engine.

Results: The total sample size was 22 patients. The mean age was 59.5 years, and 12 patients were female. The cerebrovascular pathologies were 17 cases of acute ischemic stroke, 3 cases of aneurysm rupture, and 2 cases of sinus thrombosis. Of the stroke and sinus thrombosis patients, the mean National Institute of Health Stroke Scale was 13.8 ± 8.0, and 16 (84.2%) patients underwent a mechanical thrombectomy procedure. A favorable thrombolysis in cerebral infarction score was achieved in all patients. Of the 16 patients that underwent a mechanical thrombectomy, the mortality incidence was five (31.3%). Of all patients (22), three (13.6%) patients developed hemorrhagic conversion requiring decompressive surgery. Eleven (50%) patients had a poor functional status (modified Rankin Score 3-6) at discharge, and the total mortality incidence was eight (36.4%).

Conclusions: Despite timely intervention and favorable reperfusion, the mortality rate in coronavirus disease 2019 patients with large vessel occlusion was high in our series and in the pooled analysis. Notable features were younger age group, involvement of both the arterial and venous vasculature, multivessel involvement, and complicated procedures due to the clot consistency and burden.

Keywords: Coronavirus disease 2019; angiotensin (1–7); angiotensin-converting enzyme 2; cerebral venous thrombosis; cerebrovascular disease; hypercoagulable; severe acute respiratory syndrome coronavirus 2; stroke; thrombectomy.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Betacoronavirus*
  • Brain Ischemia / diagnosis
  • Brain Ischemia / epidemiology*
  • Brain Ischemia / virology*
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology
  • Female
  • Humans
  • Intracranial Hemorrhages / diagnosis
  • Intracranial Hemorrhages / epidemiology*
  • Intracranial Hemorrhages / virology*
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology
  • Retrospective Studies
  • SARS-CoV-2
  • Survival Rate