ABSTRACT
Objective: We aimed to describe the clinical and radiographic characteristics of patients who were admitted with COVID-19 and had an acute ischemic stroke. Background: 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. Design/Methods: This is a case series of PCR-confirmed COVID-19 patients with ischemic stroke admitted to an academic health system in Atlanta, Georgia (USA) between March 24th, 2020 and July 17th, 2020. Demographic, clinical, and radiographic characteristics were described. Results: Of 396 ischemic stroke patients admitted during this study period, 13 (2.5%) were also diagnosed with COVID-19. The mean age of patients was 61.6 ± 10.8 years, 10 (76.9%) male, 8 (61.5%) were Black Americans, mean time from last normal was 4.97 ± 5.1 days, and only one received acute reperfusion therapy. All 13 patients had at least one stroke-associated comorbidity. The predominant pattern of ischemic stroke was embolic with 4 explained by atrial fibrillation. COVID-19 patients had a significantly higher rate of cryptogenic stroke than nonCOVID-19 patients during the study period (69% vs 17%, p=0.0001). 4 patients (30.7%) died by the end of the study period. Conclusions: In our case series, ischemic stroke affected COVID-19 patients with traditional stroke risk factors, but mainly affecting males and Black Americans. We observed a predominantly embolic pattern of stroke with a higher than expected rate of cryptogenic strokes, a prolonged median time to presentation and symptom recognition limiting the use of acute reperfusion treatments along with a high mortality. These results highlight the need for increased community awareness, early identification, and management of AIS in COVID-19 patients. Further studies to determine the effects of COVID-19 associated coagulopathy on ischemic stroke risk as well as the interactions between COVID-19 and other known stroke risk factors are warranted.