Acute Cerebrovascular Events With COVID-19 Infection
Authors: Dhamoon Mandip S. , Thaler Alison , Gururangan Kapil , Kohli Amit , Sisniega Daniella , Wheelwright Danielle , Mensching Connor , Fifi Johanna T. , Fara Michael G. , Jette Nathalie , Cohen Ella , Dave Priya , DiRisio Aislyn C. , Goldstein Jonathan , Loebel Emma M. , Mayman Naomi A. , Sharma Akarsh , Thomas Daniel S. , Vega Perez Ruben D. , Weingarten Mark R. , Wen Huei Hsun , Tuhrim Stanley , Stein Laura K. , Weinberger Jesse , Horowitz Deborah , Sheinart Kara , Kummer Benjamin , Hao Qing , Roche Tara , Gizaw Mahalet , Stefanowski Kamil , Goswami Vaibhav , Mocco J , Oxley Thomas , Majidi Shahram , Singh Inder Paul , Shoirah Hazem , DeLeacy Reade , Kellner Christopher , Shimegatsu Tomoyoshi , Yim Benjamin , Ladner Travis , Yaeger Kurt , Skliut Maryna , Boniece Irene , Brockington Carolyn , Dass Punam , Nasrallah Eli , Rudolph Steven , Morhaim Holly , Liang John , Reynolds Alexandra , Dengayach Neha , Lay Cappi , Reilly Kate , Cheung Helen , Chiu Daniel , Peschansky Veronica , Levy Sarah , Erdman John , Baron Rebecca , Charytonowicz Daniel , Gentile Caroline , Lange Marcia , Lurie Jacob , O’Mary Rio , Pai Akila , Sastow Dahniel , Sharma Himanshu , Solmssen Charlotte , Perez Ruben Vega 
Published: December 2020

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.