COVID-19 Respiratory Illness and Subsequent Cerebrovascular Events, the Initial Iranian Experience

J Stroke Cerebrovasc Dis. 2021 Jan;30(1):105454. doi: 10.1016/j.jstrokecerebrovasdis.2020.105454. Epub 2020 Nov 6.


Objectives: COVID-19 disproportionately affects older adults and individuals with cardiovascular co-morbidities. This report presents fifteen patients who had COVID-19 respiratory illness followed by cerebrovascular events.

Materials and methods: A call by the Iranian Neurological Association gathered cases across the country who developed neurological symptoms attributed to hemorrhagic or ischemic stroke after a definite or probable Covid-19 respiratory illness. Definite cases were those with a typical respiratory illness, positive nasopharyngeal Covid-19 PCR test, and chest CT consistent with Covid-19 infection. Probable cases were defined by a typical respiratory illness, history of contacts with a Covid-19 case, and chest CT characteristic for Covid-19 infection.

Results: Fifteen patients (12 men and 3 women) with an age range of 38 to 93 years old (median: 65 years old) were included. Fourteen patients had a first-ever acute ischemic stroke and one patient had a subarachnoid hemorrhage. Eleven patients (73%) had previous cardiovascular comorbidities. The median time between respiratory symptoms and neurological symptoms was seven days (range 1-16 days). Stroke severity in two patients was mild (NIHSS ≤ 6), in six patients moderate (NIHSS: 7-12), and in seven patients severe (NIHSS ≥13). One patient received intravenous tissue plasminogen activator ( IV-tPA) with improved neurological symptoms. Six out of 15 patients (40%) died. All but one of those who survived had significant disability assessed by a modified ranking scale >2. The majority of patients in this case series had vascular risk factors and their stroke was associated with severe disability and death.

Conclusion: This report highlights the need for further investigation of the links between Covid-19 and cerebrovascular events.

Keywords: Brain; COVID-19; Cerebrovascular accident; SARS-CoV-2; Stroke.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / mortality
  • COVID-19 / therapy
  • Cerebrovascular Disorders / diagnosis
  • Cerebrovascular Disorders / etiology*
  • Cerebrovascular Disorders / mortality
  • Cerebrovascular Disorders / therapy
  • Disability Evaluation
  • Female
  • Humans
  • Iran
  • Male
  • Middle Aged
  • Recovery of Function
  • Risk Factors
  • Severity of Illness Index
  • Thrombolytic Therapy
  • Treatment Outcome