Cerebrovascular Manifestations of COVID-19 in Young Adults

Objective: The aim of this study was to characterize patients hospitalized with COVID-19 and cerebrovascular disease, with a focus on young patients diagnosed with CVST and ICH/SAH. Background: There have been many reported neurologic manifestations of coronavirus disease 2019 (COVID-19) including cerebrovascular events such as ischemic stroke, hemorrhagic stroke including intracerebral hemorrhage/subarachnoid hemorrhage (ICH/SAH) and central venous sinus thrombosis (CVST). However, there has not been much focus on this topic in young adults aged under 50. Design/Methods: Retrospective chart review was used to obtain parameters of patients hospitalized in Chicago area hospitals with COVID-19 and a neurologic diagnosis including acute ischemic stroke, subarachnoid hemorrhage, intracranial hemorrhage, and cerebral venous sinus thrombosis. Data including patients' comorbidities and disease course was entered into a secure database by representatives from 4 different tertiary care centers. Results: A total of 27 patients aged 18 to 50 were hospitalized in Chicago land tertiary care centers from March 30, 2020 to February 1, 2021 with cerebrovascular disease and concurrently tested positive for COVID-19. Of these patients, 2 were found to have venous sinus thrombosis. 9 patients had hemorrhagic strokes, of these, 4 patients with ICH were thought to have had spontaneous hemorrhages. 9 of 27 patients had no past medical history. Conclusions: This population had a large portion, 11 out of 27 patients, with non-ischemic cerebrovascular insults such as CVST, ICH, or SAH while concurrently infected with COVID-19. Unlike most classic patients who develop these conditions, our population did not have traditional risk factors such as smoking or hypertension. Systemic inflammation, hypoxia, platelet dysfunction, or hyper-coagulability due to COVID-19 are theorized as the cause of these cerebrovascular manifestations in the absence of traditional risk factors. Spontaneous cerebrovascular manifestations of COVID-19 continue to be investigated, particularly in younger patients without traditional risk factors.

Neurologic manifestations of COVID-19 in a diverse population in chicago, Illinois

Objective: NA Background: We aimed to further characterize the neurologic manifestations observed in patients hospitalized with Coronavirus disease 2019 (COVID-19), particularly ischemic stroke in a diverse population. Design/Methods: We retrospectively reviewed data records of 50 patients with COVID-19 (48% African American and 24% Latino) who were evaluated by the neurology services in 2020. Patients were categorized into 2 groups based on timing of developing neurological manifestations: the "Neuro first" group had neurological manifestations upon initial assessment, and the "COVID first" group developed neurological symptoms greater than 24 hours after hospitalization. The demographics, comorbidities, disease severity and neurological symptoms of both groups were analyzed. Statistical analysis was performed to compare the two groups. We further analyzed acute ischemic stroke patients by comparing with historic patients with AIS without COVID-19 admitted in the same time frame in 2019 and 2020. Results: Most common neurological manifestations observed were encephalopathy (n = 30), cerebrovascular disease (n = 20), cognitive impairment (n = 13), seizures (n = 13), hypoxic brain injury (n = 7), dysgeusia (n = 5), and extraocular movement abnormalities (n = 5). The "COVID- 19 first" group had more severe/critical disease course (83.3% vs 53.8%, p 0.025). Out of 13 patients with AIS and COVID-19, Latinos and African Americans compromised the majority of our cohort (76.8%). Most strokes were cortical (84.6%) and more than 50% had no identifiable source. COVID-19 was associated with discharge to mRS>2 (p 0.046, OR 3.82, CI 1.02-14.3). Conclusions: Neurologic manifestations of COVID-19 are highly variable and can occur prior to the diagnosis of or as a complication of the viral infection. The COVID-19 patients who developed neurologic symptoms later in hospitalization had more severe disease courses. We noted a high percentage of African American and Latino individuals in both groups. Concurrent AIS and COVID-19 was associated with worse outcomes.

Characteristics of a diverse cohort of stroke patients with sars-cov-2 and outcome by sex

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. We describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease, and investigate the role of sex on outcome. Methods: This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers from Chicago metropolitan area. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. Results: The study included 83 patients. Median age was 64 years and the majority were Blacks (47%) followed by Hispanics (28%) and whites (16%). Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Higher proportions of male experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%;p=0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%).Compared to female, males had higher mortality (38% vs. 13%;p=0.02) and were less likely to bedischarged home (12% vs. 33%;p=0.04). After adjustment for age, race/ethnicity, and number ofVRFs, mRS was higher in males than in females (OR=1.47, 95% CI=1.03-2.09) Conclusion: In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence ofcoronavirus infection on admission and preexisting VRFs. Severe in-hospital complications andworse outcomes after ischemic strokes were higher in males, than females.

Characteristics of a Diverse Cohort of Stroke Patients with SARS-CoV-2 and Outcome by Sex.

BACKGROUND AND PURPOSE: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. To objective of this paper is to describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex on outcome. METHODS: This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage or median and interquartile range. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. RESULTS: The study included 83 patients, 47% of which were Black, 28% Hispanics/Latinos, and 16% whites. Median age was 64 years. Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p = 0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared with females, males had higher mortality (38% vs. 13%; p = 0.02) and were less likely to be discharged home (12% vs. 33%; p = 0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR = 1.47, 95% CI = 1.03-2.09). CONCLUSION: In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females.