Acute Stroke in COVID-19 Patients

Abstract

The novel Coronavirus-19 (COVID-19) outbreak has brought unprecedented implications globally for the medical community and continues to present challenges when delivering neurological care and intervention. Here we describe six patients with acute cerebrovascular symptoms and concurrent COVID-19 infection who presented to our hospital. This is a retrospective case series study of six patients presenting with neurological, either with or without respiratory symptoms. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was suspected in the patients. Testing was conducted by BioReference Lab with the reverse-transcriptase polymerase chain reaction (RT-PCR) assay for most patients. Brain imaging revealed evidence of acute cerebral infarction. Ethical approval and informed consent waivers when appropriate were granted by the Mount Sinai Institutional Review Board. The study was conducted at NYC Health + Hospitals-Queens in Jamaica, New York. All patients were men, ages 39 to 69 years, four of whom were found to have associated risk factors for stroke. Inflammatory markers were elevated in most patients and brain imaging revealed ischemic infarcts. With the exception of one patient who expired, five patients made a significant recovery. Ischemic stroke was one of many newfound complications related to the COVID-19 infection. In our case reports, many patients did not present with respiratory symptoms, however, all tested positive for COVID-19. Neurological sequelae related to COVID-19 apart from cerebrovascular disease continue to be discovered. With growing evidence that the central nervous system is vulnerable to the devastating effects of COVID-19, testing should be expedited in all patients presenting with neurological symptoms during the COVID-19 pandemic.