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Original research
Stroke in COVID-19: a single-centre initial experience in a hotspot of the pandemic
  1. Ivo Bach1,
  2. Pratibha Surathi1,
  3. Nora Montealegre1,
  4. Osama Abu-Hadid1,
  5. Sara Rubenstein1,
  6. Sviatoslav Redko1,
  7. Siddharth Gupta1,
  8. Machteld Hillen1,
  9. Pratit Patel2,
  10. Priyank Khandelwal2,
  11. Adham Kamel1
  1. 1 Department of Neurology and Neurosciences, New Jersey Medical School, Newark, New Jersey, USA
  2. 2 Department of Neurological Surgery, New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to Dr Ivo Bach; Ivo.Bach{at}Rutgers.edu

Abstract

Background COVID-19, caused by SARS-CoV-2, is a global pandemic that has been an immense burden on healthcare systems all over the world. These patients may be at higher risk for acute ischaemic stroke (AIS). We present our experience with AIS in patients with COVID-19.

Methods We reviewed all patients admitted to our hospital during a 6-week period with a positive nasopharyngeal swab test for SARS-CoV-2. Among these patients, we identified AIS. We reviewed the demographics, clinical, laboratory, imaging characteristics, treatments received and outcomes of AIS in patients with COVID-19.

Results We identified 683 patients admitted with COVID-19 during the study period, of which 20 patients had AIS. Large-vessel occlusion (LVO) was noted in 11 patients (55%). Intravenous alteplase was administered in four patients (20%) and mechanical thrombectomy was performed in five patients (25%). Respiratory symptoms preceded the onset of AIS in most of the patients (70%) by 1 to 21 days. Mortality in patients with AIS was 50% compared with 26% of all COVID-19 admissions. Most of these patients died due to non-neurological causes (70%). Three patients with AIS had clinical and imaging findings consistent with COVID-19, but were negative for multiple nasopharyngeal swab tests.

Interpretation LVO was more common in patients with AIS and COVID-19. They had more severe disease and higher mortality rates. Most of the patients had respiratory symptoms preceding AIS by days to weeks. This could explain certain patients with clinical picture of COVID-19 but negative nasopharyngeal swab tests.

  • stroke
  • infection
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2020-000525

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    Footnotes

    • Twitter @Ivobach

    • Contributors IB and NM contributed to study concept and design, data collection, interpretation of data, literature search, drafting of manuscript, critical revision and final approval. PS contributed to study concept and design, data collection, literature search, drafting of manuscript, analysis and interpretation of data, critical revision and final approval. OA-H contributed to study design, literature search, drafting of manuscript, analysis and interpretation of data and final approval.

      SRubenstein contributed to data collection, literature search, interpretation of data, drafting of manuscript, critical revision and final approval. SRedko contributed to study design, data collection, interpretation of data and final approval. SG contributed to data collection and critical revision. MH contributed to critical revision, interpretation of data and final approval. PP contributed to critical revision, literature search, interpretation of data and final approval. PK (Co-Guarantor) contributed to study concept, critical revision, interpretation of data and final approval. AK (Co-Guarantor/PI) contributed to study concept, critical revision, interpretation of data and final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the institutional review board of Rutgers University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All relevant data is included in the article or tables. Data is not publicly available at this time.