Acute Cerebrovascular Events in Hospitalized COVID-19 Patients

Stroke. 2020 Sep;51(9):e219-e222. doi: 10.1161/STROKEAHA.120.030995. Epub 2020 Jul 20.

Abstract

Background and purpose: Initial reports suggest a significant risk of thrombotic events, including stroke, in patients hospitalized with coronavirus disease 2019 (COVID-19). However, there is little systematic data on stroke incidence and mechanisms, particularly in racially diverse populations in the United States.

Methods: We performed a retrospective, observational study of stroke incidence and mechanisms in all patients with COVID-19 hospitalized from March 15 to May 3, 2020, at 3 Philadelphia hospitals.

Results: We identified 844 hospitalized patients with COVID-19 (mean age 59 years, 52% female, 68% Black); 20 (2.4%) had confirmed ischemic stroke; and 8 (0.9%) had intracranial hemorrhage. Of the ischemic stroke patients, mean age was 64 years, with only one patient (5%) under age 50, and 80% were Black. Conventional vascular risk factors were common, with 95% of patients having a history of hypertension and 60% a history of diabetes mellitus. Median time from onset of COVID symptoms to stroke diagnosis was 21 days. Stroke mechanism was cardioembolism in 40%, small vessel disease in 5%, other determined mechanism in 20%, and cryptogenic in 35%. Of the 11 patients with complete vascular imaging, 3 (27%) had large vessel occlusion. Newly positive antiphospholipid antibodies were present in >75% of tested patients. Of the patients with intracranial hemorrhage, 5/8 (63%) were lobar intraparenchymal hemorrhages, and 3/8 (38%) were subarachnoid hemorrhage; 4/8 (50%) were on extracorporeal membrane oxygenation.

Conclusions: We found a low risk of acute cerebrovascular events in patients hospitalized with COVID-19. Most patients with ischemic stroke had conventional vascular risk factors, and traditional stroke mechanisms were common.

Keywords: coronavirus; diabetes mellitus; hypertension; incidence; population.

Publication types

  • Observational Study

MeSH terms

  • African Continental Ancestry Group
  • Aged
  • Brain Ischemia / complications
  • Brain Ischemia / epidemiology
  • COVID-19
  • Cerebrovascular Disorders / complications*
  • Cerebrovascular Disorders / epidemiology*
  • Coronavirus Infections / complications*
  • Coronavirus Infections / epidemiology*
  • Diabetes Complications / epidemiology
  • Female
  • Humans
  • Hypertension / complications
  • Incidence
  • Inpatients
  • Intracranial Hemorrhages / complications
  • Intracranial Hemorrhages / epidemiology
  • Male
  • Middle Aged
  • Pandemics
  • Philadelphia / epidemiology
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Stroke / complications
  • Stroke / epidemiology
  • Thrombosis / complications
  • Thrombosis / epidemiology