Evaluation of Stroke Frequency in COVID-19 Patients

Abstract

Objective: Neurological symptoms occur due to central and peripheral nervous system involvement with different mechanisms in coronavirus disease 2019 (COVID-19). Microvascular thrombosis develops with prothrombotic activation along with the increase in cytokines in COVID-19 infection. We aimed to investigate the incidence of cerebrovascular disease and concomitant risk factors in COVID-19 positive patients.

Materials and Methods: Acute and temporally related cerebrovascular diseases with a diagnosis of COVID-19 were evaluated. Cerebrovascular events were assessed in 4 groups as ischemic and hemorrhagic events, transient ischemic attacks, and cerebral venous thrombosis. Risk factors for cerebrovascular disease in these patients were also assessed, and which risk factors for cerebrovascular diseases in COVID-19 patients are high risk were examined.

Results: Of the 1000 patients with COVID-19 disease were evaluated. Ischemic cerebrovascular disease and/or transient ischemic attack were found in 14 patients (1.4%). The most common symptoms related to COVID-19 were fever and respiratory distress in 14 patients with acute ischemic stroke diagnosed with COVID-19.

Conclusion: COVID-19 increases the risk of stroke in patients with multiple risk factors. Close follow-up should be performed more carefully, especially in patients with pulmonary involvement and acute ischemic stroke, because mortality is likely to be higher. 

Keywords

• COVID-19
• stroke
• cerebrovascular diseases

COVID-19 Hastalarında İnme Sıklığının Değerlendirilmesi

Öz

Amaç: Koronavirüs hastalığı 2019 (COVID-19) hastalarında merkezi ve periferik sinir sisteminin farklı mekanizmalarla tutulumuna bağlı olarak nörolojik semptomlar ortaya çıkmaktadır. COVID-19 enfeksiyonunda sitokin artışı ile birlikte protrombotik aktivasyon ile mikrovasküler tromboz gelişmektedir. Bu çalışmada COVID-19 pozitif hastalarda serebrovasküler hastalık insidansını ve eşlik eden risk faktörlerini araştırmayı amaçladık.

Materyal ve Metot: COVID-19 tanısı alan hastalarda hastalıkla ilişkili olarak ortaya çıkan serebrovasküler hastalık durumu değerlendirildi. Serebrovasküler olaylar iskemik ve hemorajik olaylar, geçici iskemik ataklar ve serebral ven trombozu olmak üzere 4 grupta değerlendirildi. Bu hastalarda serebrovasküler hastalık için risk faktörleri ve bu risk faktörlerinin COVID-19 hastalarında serebrovasküler hastalık durumunda prognoza etkisi değerlendirildi.

Bulgular: Çalışmada COVID-19 tanısı alan 1000 hasta değerlendirildi. On dört hastada (%1,4) iskemik serebrovasküler hastalık ve/veya geçici iskemik atak geliştiği görüldü. Bu durum COVID-19 tanısı alındıktan sonraki ilk hafta içinde izlendi. COVID-19 ile teşhis edilen akut iskemik inmeli 14 hastada COVID-19 ile ilgili en yaygın semptomlar ateş ve solunum sıkıntısı idi.

Sonuç: COVID-19, birden fazla risk faktörü olan hastalarda inme riskini artırıyor. Özellikle pulmoner tutulumlu ve akut iskemik inmeli hastalarda mortalite daha yüksek olabileceğinden yakın takip daha dikkatli yapılmalıdır. 

Anahtar Kelimeler

• COVID-19
• inme
• serebrovasküler hastalıklar

References

1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5
2. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395(10223):507-513. doi:10.1016/S0140-6736(20)30211-7
3. Garg RK. Spectrum of neurological manifestations in Covid-19: A review. Neurol India. 2020;68(3):560-572. doi:10.4103/0028-3886.289000
4. Lyden P. Temporary emergency guidance to US stroke centers during the COVID-19 pandemic on behalf of the AHA/ASA Stroke Council Leadership. Stroke. 2020;51(6):1910-1912. doi:10.1161/STROKEAHA.120.030023
5. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5
6. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-847. doi:10.1111/jth.14768
7. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. doi:10.1001/jamaneurol.2020.1127
8. Beyrouti R, Adams ME, Benjamin L, et al. Characteristics of ischaemic stroke associated with COVID-19.J Neurol Neurosurg Psychiatry. 2020;91(8):889-891. doi: 10.1136/jnnp-2020-323586

9. Alger HM, Rutan C, Williams JH, et al. American Heart Association COVID-19 CVD registry powered by get with the guidelines. Circ Cardiovasc Qual Outcomes. 2020;13(8):e006967. doi:10.1161/CIRCOUTCOMES.120.006967
10. Qureshi AI, Baskett WI, Huang W, et al. Acute ischemic stroke and COVID-19: An analysis of 27676 patients. Stroke. 2021;52(3):905-912. doi:10.1161/STROKEAHA.120.031786
11. Ramos-Araque ME, Siegler JE, Ribo M, et al. Stroke etiologies in patients with COVID-19: The SVIN COVID-19 multinational registry. BMC Neurol. 2021;21(1):1-11. doi:10.1186/s12883-021-02075-1
12. Paterson RW, Brown RL, Benjamin L, et al. The emerging spectrum of COVID-19 neurology: Clinical, radiological and laboratory findings. Brain. 2020;143(10):3104-3120. doi:10.1093/brain/awaa240
13. Kumar J, Makheja K, Rahul F, et al. Long-term neurological impact of COVID-19. Cureus. 2021;13(9):3-7. doi:10.7759/cureus.18131
14. 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 Neurointerv Surg. 2021;13(3):202-206. doi:10.1136/neurintsurg-2020-016794
15. Qin C, Zhou L, Hu Z, et al. Clinical characteristics and outcomes of COVID-19 patients with a history of stroke in Wuhan, China. Stroke. 2020;51(7):2219-2223. doi:10.1161/STROKEAHA.120.030365
16. Yaghi S, Ishida K, Torres J, et al. SARS-CoV-2 and stroke in a New York healthcare system. Stroke. 2020;51(7):2002-2011. doi:10.1161/STROKEAHA.120.030335
17. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3