Stroke as a presenting symptom of COVID-19; A study of risk factors, characteristics and outcomes in a sample of Egyptian patients

Abstract

Background : It is not known whether patients with coronavirus disease 2019 (COVID-19)-associated stroke have worse functional and vital outcomes than those without infection. Aim and objectives : To compare between COVID-19-associated stroke and non-COVID-19-associated stroke cases regarding risk factors, characteristics, and outcome. Patients and methods : In a prospective study, 297 patients diagnosed clinically and radiologically as having stroke and admitted to Emergency Department and stroke unit of Al-Azhar University hospitals were recruited in the period from beginning of December 2021 to the end of May 2022. They were classi fi ed into ischemic stroke (IS), cerebral venous thrombosis, subarachnoid hemorrhage, and intracerebral hemorrhage groups. Workup for COVID-19 was done in each group followed by comparison between both groups. Results : We evaluated 297 patients, and 46 (15.4%) had COVID-19 infection. In IS group, age, hypertension, and previous cerebrovascular stroke were signi fi cantly lower. Large vessel occlusion, median baseline National Institutes of Health Stroke Scale score, and serum ferritin were signi fi cantly higher in COVID-19-associated IS group. Moreover, COVID-19-associated IS had a worse outcome regarding median Modi fi ed Rankin scale, hemorrhagic transformation, and mortality rate. According to TOAST classi fi cation, cryptogenic subtype was signi fi cantly higher in COVID-19-associated IS group. Lymphocyte (%) was signi fi cantly lower but D-dimer was signi fi cantly higher in COVID-19-infected patients in all stroke groups. Conclusion : Patients with COVID-19-associated IS have more severe strokes, worse functional outcome, and a higher mortality than those without infection.