Characteristics of Ischemic Stroke in COVID-19: A Need for Early Detection and Management

Objective: In the setting of the Coronavirus Disease 2019 (COVID-19) global pandemic caused by SARS-CoV-2, a potential association of this disease with stroke has been suggested. We aimed to describe the characteristics of patients who were admitted with COVID-19 and had an acute ischemic stroke (AIS). Methods: This is a case series of PCR-confirmed COVID-19 patients with ischemic stroke admitted to an academic health system in metropolitan Atlanta (USA) between March 24th,2020, and May 5th, 2020. Demographic, clinical, and radiographic characteristics were described. Results: Of 124 ischemic stroke patients admitted during this study period, 8 (6.5%) were also diagnosed with COVID-19. The mean age of patients was 64.3 +/- 6.5 years, 5 (62.5%) male, mean time from last-normal was 4.8 days [SD 4.8], and none received acute reperfusion therapy. All 8 patients had at least one stroke-associated co-morbidity. The predominant pattern of ischemic stroke was embolic; 3 were explained by atrial fibrillation while 5 (62.5%) were cryptogenic. In contrast, cryptogenic strokes were seen in 20 (16.1%) of 124 total stroke admissions during this time. Conclusions: In our case series, ischemic stroke affected COVID-19 patients with traditional stroke risk factors with an age of stroke presentation typically seen in non-COVID populations. We observed a predominantly embolic pattern of stroke with a higher than expected rate of cryptogenic strokes and with a prolonged median time to presentation/symptom recognition limiting the use of acute reperfusion treatments. These results highlight the need for aggressive identification and management of AIS in COVID-19 patients.