Clinical comparison of acute stroke cases with and without COVID-19

Year 2024, , 81 - 89, 29.04.2024

Hatice Barut , Cemile Haki , Mustafa Barut

https://doi.org/10.46310/tjim.1293458

Abstract

Background We aimed to assess acute stroke cases with and without coronavirus disease 2019 (COVID-19) positivity concerning clinical features and the number of hospitalizations acute stroke cases compared to the previous year.
Methods Acute stroke patients with and without COVID-19 positivity, including those who were hospitalized in the neurology service and intensive care unit of tertiary healthcare center between 17 December 2020 and 31 January 2021 due to acute stroke, were included in this cross-sectional study.
Results Mortality (p=0.042) and mechanical ventilation use (p=0.041) were more frequent in COVID-19-positive stroke patients compared to those without COVID-19. The most common type of stroke in COVID-19-positive acute stroke patients was ischemic stroke (69.23%). Additionally, stroke patients with COVID-19 had a significantly higher percentage of kidney disease compared to those without COVID-19 (p=0.009). We also observed that the number of acute stroke cases hospitalized in our hospital during the pandemic decreased significantly compared to the previous year (p=0.036).
Conclusion Since the majority of our patients were diagnosed with COVID-19 after admission to the hospital due to stroke, it should be kept in mind that patients who apply to the hospital with stroke symptoms may also have COVID-19, even if they are asymptomatic.

Keywords

Covid-19, acute cerebrovascular disease, stroke, symptoms

References

• Delorme C, Paccoud O, Kas A, Hesters A, Bombois S, Shambrook P, Boullet A, Doukhi D, Le Guennec L, Godefroy N, Maatoug R, Fossati P, Millet B, Navarro V, Bruneteau G, Demeret S, Pourcher V; CoCo-Neurosciences study group and COVID SMIT PSL study group. COVID-19-related encephalopathy: a case series with brain FDG-positron-emission tomography/computed tomography findings. Eur J Neurol. 2020 Dec;27(12):2651-7. doi: 10.1111/ene.14478.
• Zambreanu L, Lightbody S, Bhandari M, Hoskote C, Kandil H, Houlihan CF, Lunn MP. A case of limbic encephalitis associated with asymptomatic COVID-19 infection. J Neurol Neurosurg Psychiatry. 2020 Nov;91(11):1229-30. doi: 10.1136/jnnp-2020-323839.
• Khoo A, McLoughlin B, Cheema S, Weil RS, Lambert C, Manji H, Zandi MS, Morrow JM. Postinfectious brainstem encephalitis associated with SARS-CoV-2. J Neurol Neurosurg Psychiatry. 2020 Sep;91(9):1013-1014. doi: 10.1136/jnnp-2020-323816.
• Durmaz ŞE, Kaya BU, Gümüşyayla Ş. Association Between Guillain-Barré Syndrome and COVID-19 Infection: Experience of a Turkish Neurophysiology Laboratory. Noro Psikiyatr Ars. 2022 Nov 7;59(4):255-9. doi: 10.29399/npa.27855.
• Türk Börü Ü, Köseoğlu Toksoy C, Bölük C, Demirbaş H, Yılmaz AÇ. A case of Guillain-Barré syndrome related to COVID-19 infection. Int J Neurosci. 2023 Jan;133(1):86-8. doi: 10.1080/00207454.2021.1886097.
• Chang S, Schecht M, Jain R, Belani P. Acute neurological complications of coronavirus disease. Neuroimaging Clin N Am. 2023 Feb;33(1):57-68. doi: 10.1016/j.nic.2022.07.003.
• Czarnowska A, Zajkowska J, Kułakowska A. Impact of SARS-CoV-2 on the nervous system. Neurol Neurochir Pol. 2023;57(1):26-35. doi: 10.5603/PJNNS.a2023.0009.
• Usta NC, Kartal S, Gunay BO, Boz C. Neurological manifestations and etiological risk factors in patients hospitalized with COVID-19 in Turkey. Asian Biomed (Res Rev News). 2022 Feb 28;16(1):23-30. doi: 10.2478/abm-2022-0004.
• Alay H, Can FK, Gözgeç E. Cerebral infarction in an elderly patient with coronavirus disease. Rev Soc Bras Med Trop. 2020 Jun 3;53:e20200307. doi: 10.1590/0037-8682-0307-2020.
• Hernández-Fernández F, Sandoval Valencia H, Barbella-Aponte RA, Collado-Jiménez R, Ayo-Martín Ó, Barrena C, Molina-Nuevo JD, García-García J, Lozano-Setién E, Alcahut-Rodriguez C, Martínez-Martín Á, Sánchez-López A, Segura T. Cerebrovascular disease in patients with COVID-19: neuroimaging, histological and clinical description. Brain. 2020 Oct 1;143(10):3089-103. doi: 10.1093/brain/awaa239.
• Finsterer J, Scorza FA, Scorza CA, Fiorini AC. Ischemic stroke in 455 COVID-19 patients. Clinics (Sao Paulo). 2022 Feb 14:77:100012. doi: 10.1016/j.clinsp.2022.100012.
• Dallas J, Liu KQ, Wenger TA, Lin M, Ding L, Attenello FJ, Mack WJ. The effect of COVID-19 on treatment and outcomes following ischemic stroke: A national assessment. Clin Neurol Neurosurg. 2023 Oct;233:107982. doi: 10.1016/j.clineuro.2023.107982.
• Görgülü Ü, Şahin MH, Bektaş H. Acute stroke in Covid-19 infection: Neurology intensive care experience. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2022;13(1):111-8 (in Turkish). Doi: 10.22312/sdusbed.1069267.
• Luo W, Liu X, Bao K, Huang C. Ischemic stroke associated with COVID-19: a systematic review and meta-analysis. J Neurol. 2022 Apr;269(4):1731-40. doi: 10.1007/s00415-021-10837-7.
• Pourciau P, Smith BC. Stroke risk related to coronavirus disease-2019: What have we learned? Crit Care Nurs Clin North Am. 2023 Mar;35(1):53-65. doi: 10.1016/j.cnc.2022.10.001.
• Demirelli DS, Genc G, Basarir CI, Bulut S. Comparison of clinical characteristics of COVID-19-related and unrelated acute stroke patients during the COVID-19 pandemic in Turkey. Sisli Etfal Hastan Tip Bul. 2022 Mar 28;56(1):55-61. doi: 10.14744/SEMB.2021.65785.
• Cerón Blanco N, Romero Hernández CA, Vallejo Fernández J. Acute stroke in COVID-19 patients: A first year experience in a Colombian hospital. Neurol Perspect. 2023 Apr-Jun;3(2):100121. doi: 10.1016/j.neurop.2023.100121.
• Benny R, Singh RK, Venkitachalam A, Lalla RS, Pandit RA, Panchal KC, Pardasani V, Chanchalani G, Basle M, Bolegave V, Manoj H, Shetty AN, Shah AM, Pai P, Banthia NM, Patil SG, Chafale V, Pujara B, Shah S, Mehta N, Thakkar VV, Patel V, Shetty KV. Characteristics and outcomes of 100 consecutive patients with acute stroke and COVID-19. J Neurol Sci. 2021 Apr 15;423:117348. doi: 10.1016/j.jns.2021.117348.
• García-Moncó JC, Cabrera-Muras A, Collía-Fernández A, Erburu-Iriarte M, Rodrigo-Armenteros P, Oyarzun-Irazu I, Martínez-Condor D, Bilbao-González A, Carmona-Abellán M, Caballero-Romero I, Gómez-Beldarrain M. Neurological reasons for consultation and hospitalization during the COVID-19 pandemic. Neurol Sci. 2020 Nov;41(11):3031-8. doi: 10.1007/s10072-020-04714-w.
• Oliveira IB, Pessoa MS, Lima CF, Holanda JL, Coimbra PPA. Ischaemic stroke as an initial presentation in patients with COVID-19: evaluation of a case series in an emergency in Brazil. Neuroradiol J. 2021 Aug;34(4):308-12. doi: 10.1177/1971400920987357.
• Tan YJ, Narasimhalu K, Chan Y, De Silva DA. Stroke patients without COVID-19 symptoms: Is there a need to screen? Neurologist. 2021 Mar 4;26(2):73-4. doi: 10.1097/NRL.0000000000000305.
• Tunç A, Ünlübaş Y, Alemdar M, Akyüz E. Coexistence of COVID-19 and acute ischemic stroke report of four cases. J Clin Neurosci. 2020 Jul:77:227-9. doi: 10.1016/j.jocn.2020.05.018.
• Davis MG, Gangu K, Suriya S, Maringanti BS, Chourasia P, Bobba A, Tripathi A, Avula SR, Shekhar R, Sheikh AB. COVID-19 and acute ischemic stroke mortality and clinical outcomes among hospitalized patients in the United States: Insight from national inpatient sample. J Clin Med. 2023 Feb 8;12(4):1340. doi: 10.3390/jcm12041340.
• Ferrone SR, Sanmartin MX, Ohara J, Jimenez JC, Feizullayeva C, Lodato Z, Shahsavarani S, Lacher G, Demissie S, Vialet JM, White TG, Wang JJ, Katz JM, Sanelli PC. Acute ischemic stroke outcomes in patients with COVID-19: a systematic review and meta-analysis. J Neurointerv Surg. 2024 Mar 14;16(4):333-341. doi: 10.1136/jnis-2023-020489.
• Siow I, Lee KS, Zhang JJY, Saffari SE, Ng A, Young B. Stroke as a neurological complication of COVID-19: A systematic review and meta-analysis of incidence, outcomes and predictors. J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105549. doi: 10.1016/j.jstrokecerebrovasdis.2020.105549.
• Topcuoglu MA, Pektezel MY, Oge DD, Bulut Yüksel ND, Ayvacioglu C, Demirel E, Balci S, Arat A, Akinci SB, Arsava EM. Stroke mechanism in COVID-19 infection: A prospective case-control study. J Stroke Cerebrovasc Dis. 2021 Aug;30(8):105919. doi: 10.1016/j.jstrokecerebrovasdis.2021.105919.
• Li S, Ren J, Hou H, Han X, Xu J, Duan G, Wang Y, Yang H. The association between stroke and COVID-19-related mortality: a systematic review and meta-analysis based on adjusted effect estimates. Neurol Sci. 2022 Jul;43(7):4049-59. doi: 10.1007/s10072-022-06024-9.
• May B, Wang DZ. Coronavirus disease 2019 infection and cerebrovascular diseases: an update on the pathophysiology and management. Curr Opin Neurol. 2023 Apr 1;36(2):155-64. doi: 10.1097/WCO.0000000000001146.
• Nannoni S, De Groot R, Bell S, Markus HS. Stroke in COVID-19: A systematic review and meta-analysis. Int J Stroke. 2021 Feb;16(2):137-49. doi: 10.1177/1747493020972922.
• Katsanos AH, Palaiodimou L, Zand R, Yaghi S, Kamel H, Navi BB, Turc G, Romoli M, Sharma VK, Mavridis D, Shahjouei S, Catanese L, Shoamanesh A, Vadikolias K, Tsioufis K, Lagiou P, Alexandrov AV, Tsiodras S, Tsivgoulis G. The impact of SARS-CoV-2 on stroke epidemiology and care: A Meta-Analysis. Ann Neurol. 2021 Feb;89(2):380-8. doi: 10.1002/ana.25967.
• Chung EYM, Palmer SC, Natale P, Krishnan A, Cooper TE, Saglimbene VM, Ruospo M, Au E, Jayanti S, Liang A, Jie Deng DJ, Chui J, Higgins GY, Tong A, Wong G, Teixeira-Pinto A, Hodson EM, Craig JC, Strippoli GFM. Incidence and outcomes of COVID-19 in people with CKD: A systematic review and meta-analysis. Am J Kidney Dis. 2021 Dec;78(6):804-15. doi: 10.1053/j.ajkd.2021.07.003.
• Gunnarsson K, Tofiq A, Mathew A, Cao Y, von Euler M, Ström JO. Changes in stroke and TIA admissions during the COVID-19 pandemic: A meta-analysis. Eur Stroke J. 2024 Mar;9(1):78-87. doi: 10.1177/23969873231204127.
• Padroni M, Laudisi M, Azzini C, De Vito A, Casetta I. Stroke admissions during the COVID-19 pandemic: a single-center retrospective analysis. Neurol Sci. 2022 Sep;43(9):5169-74. doi: 10.1007/s10072-022-06207-4.
• Nguyen TN, Qureshi MM, Klein P, Yamagami H, Mikulik R, Czlonkowska A, Abdalkader M, Sedova P, Sathya A, Lo HC, Mansour OY, Vanguru HR, Lesaine E, Tsivgoulis G, Loochtan AI, Demeestere J, Uchino K, Inoa V, Goyal N, Charidimou A, Siegler JE, Yaghi S, Aguiar de Sousa D, Mohammaden MH, Haussen DC, Kristoffersen ES, Lereis VP, Scollo SD, Campbell BCV, Ma A, Thomas JO, Parsons MW, Singhal S, Slater LA, Tomazini Martins R, Enzinger C, Gattringer T, Rahman A, Bonnet T, Ligot N, De Raedt S, Lemmens R, Vanacker P, Vandervorst F, Conforto AB, Hidalgo RCT, de Oliveira Neves L, Martins RT, Mora Cuervo DL, Rebello LC, Santiago IB, Lameirinhas da Silva I, Sakelarova T, Kalpachki R, et.al.; and the SVIN COVID-19 Global Stroke Registry. Global impact of the COVID-19 pandemic on stroke volumes and cerebrovascular events: a 1-year follow-up. Neurology. 2023 Jan 24;100(4):e408-e421. doi: 10.1212/WNL.0000000000201426.
• Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP. Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke. 2009 Jun;40(6):2068-72. doi: 10.1161/STROKEAHA.108.540112.