Abstract | March 29, 2023

Stroke and COVID-19: a review of case report trends

Mahant Malempati, BS

Mahant Malempati BS, MS2, Tulane University School of Medicine, New Orleans, Louisiana Ifechukwude J. Biose, PhD, Clinical Neuroscience Research Center, Postdoctoral Research Fellow, Tulane University School of Medicine, New Orleans, Louisiana, Timothy E. Gressett BS, MS4/PhD Candidate, Gregory J. Bix, MD, PhD, FAHA, Clinical Neuroscience Research Center, Director, Tulane University School of Medicine, New Orleans, Louisiana

Learning Objectives

  1. Understand the current pathophysiological pathways that are believed to contribute to pathogenesis of COVID-19 related stroke these include the relationship between COVID-19 inflammation and coagulopathy.
  2. Understand the physiological connection between co-morbidities the increase the likelihood of stroke for COVID-19 patients.
  3. Demonstrate which co-morbidities and clinical course patients typically follow when presenting with COVID-19 and stroke.

Introduction: Sixty-eight case reports were reviewed to determine the incidence of stroke among patients who presented with SARS-COV-2 (COVID-19) and to evaluate the impact of COVID-19 on stroke outcomes.

Method: Case reports of patients, who while hospitalized had stroke and COVID, were selected using Pubmed and Google Scholar. Inclusion criteria were recent cases (limited to a period of 2019-2022) in English language publications only. Systemic reviews were excluded from the search. We then performed an analysis on the following variables for all 68 patients: age, Covid Induced Stroke (CIS) vs. Stroke then Covid (STC), vs. Covid and Stroke (CAS), NIHSS score, type of stroke, mortality, functional outcomes, and co-morbidities listed. In addition, we compared distribution of co-morbidities, stroke type, sex and age.

Discussion: We found that the majority of patients admitted to the hospital for COVID-19 and then subsequently developed a stroke (55/68). The mechanisms by which COVID induces stroke is not completely understood however one hypothesis is that COVID-19 contributes to this increased incidence because of cytokine storm, thrombosis, platelet activation, extrinsic and intrinsic coagulation pathway activation, endothelialitis, and neutrophil extracellular traps (NETs).1 Interestingly, among the cases we included in our study, hypertension (36/67) was prevalent in more patients than diabetes mellitus (22/67) as well as when compared to other co-morbidities. This finding has been corroborated across other case reports and systemic reviews.2,3 Importantly, we observed differences in gender between the STC and CAS categories, however this may be due to the small number of patients in each category. It will be instructive to determine and characterize any sexual dimorphic inferences from a larger patient population who presented with COVID-19 and were later diagnosed with stroke.

 

References

  1. Zakeri A, Jadhav AP, Sullenger BA, Nimjee SM. Ischemic stroke in COVID-19-positive patients: an overview of SARS-CoV-2 and thrombotic mechanisms for the neurointerventionalist. J NeuroInterventional Surg. 2021;13(3):202-206. doi:10.1136/neurintsurg-2020-016794
  2. Wijeratne T, Gillard Crewther S, Sales C, Karimi L. COVID-19 Pathophysiology Predicts That Ischemic Stroke Occurrence Is an Expectation, Not an Exception—A Systematic Review. Front Neurol. 2021;11. Accessed August 8, 2022. https://www.frontiersin.org/articles/10.3389/fneur.2020.607221
  3. Qureshi AI, Baskett WI, Huang W, et al. Acute Ischemic Stroke and COVID-19. Stroke. 2021;52(3):905-912. doi:10.1161/STROKEAHA.120.031786
  4. Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Aubrey-Bassler K. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study. BMC Fam Pract. 2016;17:38. doi:10.1186/s12875-016-0440-0




Back to Abstracts