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1.
J Stroke Cerebrovasc Dis ; 31(8): 106591, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1931013

ABSTRACT

BACKGROUND: Cerebrovascular diseases (CVDs), including varying strokes, can recur in patients upon coronavirus disease 2019 (COVID-19) diagnosis, but risk factor stratification based on stroke subtypes and outcomes is not well studied in large studies using propensity-score matching. We identified risk factors and stroke recurrence based on varying subtypes in patients with a prior CVD and COVID-19. METHODS: We analyzed data from 45 health care organizations and created cohorts based on ICDs for varying stroke subtypes utilizing the TriNetX Analytics Network. We measured the odds ratios and risk differences of hospitalization, ICU/critical care services, intubation, mortality, and stroke recurrence in patients with COVID-19 compared to propensity-score matched cohorts without COVID-19 within 90-days. RESULTS: 22,497 patients with a prior history of CVD within 10 years and COVID-19 diagnosis were identified. All cohorts with a previous CVD diagnosis had an increased risk of hospitalization, ICU, and mortality. Additionally, the data demonstrated that a history of ischemic stroke increased the risk for hemorrhagic stroke and transient ischemic attack (TIA) (OR:1.59, 1.75, p-value: 0.044*, 0.043*), but a history of hemorrhagic stroke was associated with a higher risk for hemorrhagic strokes only (ORs 3.2, 1.7, 1.7 and p-value: 0.001*, 0.028*, 0.001*). History of TIA was not associated with increased risk for subsequent strokes upon COVID-19 infection (all p-values: ≥ 0.05). CONCLUSIONS: COVID-19 was associated with an increased risk for hemorrhagic strokes and TIA among all ischemic stroke patients, an increased risk for hemorrhagic stroke in hemorrhagic stroke patients, and no associated increased risk for any subsequent strokes in TIA patients.


Subject(s)
COVID-19 , Hemorrhagic Stroke , Ischemic Attack, Transient , Ischemic Stroke , Stroke , COVID-19/complications , COVID-19 Testing , Humans , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/etiology , Recurrence , Risk Factors , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapy
2.
Stroke ; 53(3): 800-807, 2022 03.
Article in English | MEDLINE | ID: covidwho-1495767

ABSTRACT

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) may be associated with increased risk for ischemic stroke. We present prevalence and characteristics of strokes in patients with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection enrolled in the American Heart Association COVID-19 Cardiovascular Disease Registry. METHODS: In this quality improvement registry study, we examined demographic, baseline clinical characteristics, and in-hospital outcomes among hospitalized COVID-19 patients. The primary outcomes were ischemic stroke or transient ischemic attack (TIA) and in-hospital death. RESULTS: Among 21 073 patients with COVID-19 admitted at 107 hospitals between January 29, 2020, and November 23, 2020, 160 (0.75%) experienced acute ischemic stroke/TIA (55.3% of all acute strokes) and 129 (0.61%) had other types of stroke. Among nonischemic strokes, there were 44 (15.2%) intracerebral hemorrhages, 33 (11.4%) subarachnoid hemorrhages, 21 (7.3%) epidural/subdural hemorrhages, 2 (0.7%) cerebral venous sinus thromboses, and 24 (8.3%) strokes not otherwise classified. Asians and non-Hispanic Blacks were overrepresented among ischemic stroke/TIA patients compared with their overall representation in the registry, but adjusted odds of stroke did not vary by race. Median time from COVID-19 symptom onset to ischemic stroke was 11.5 days (interquartile range, 17.8); median National Institutes of Health Stroke Scale score was 11 (interquartile range, 17). COVID-19 patients with acute ischemic stroke/TIA had higher prevalence of hypertension, diabetes, and atrial fibrillation compared with those without stroke. Intensive care unit admission and mechanical ventilation were associated with higher odds of acute ischemic stroke/TIA, but older age was not a predictor. In adjusted models, acute ischemic stroke/TIA was not associated with in-hospital mortality. CONCLUSIONS: Ischemic stroke risk did not vary by race. In contrast to the association between older age and death from COVID-19, ischemic stroke risk was the highest among middle-aged adults after adjusting for comorbidities and illness severity, suggesting a potential mechanism for ischemic stroke in COVID-19 independent of age-related atherosclerotic pathways.


Subject(s)
COVID-19 , Hospital Mortality , Ischemic Attack, Transient , Ischemic Stroke , Registries , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , American Heart Association , COVID-19/complications , COVID-19/mortality , COVID-19/therapy , Female , Humans , Ischemic Attack, Transient/etiology , Ischemic Attack, Transient/mortality , Ischemic Attack, Transient/therapy , Ischemic Stroke/etiology , Ischemic Stroke/mortality , Ischemic Stroke/therapy , Male , Middle Aged , United States/epidemiology
3.
J Stroke Cerebrovasc Dis ; 30(8): 105919, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1253283

ABSTRACT

BACKGROUND: The characteristics and pathophysiological mechanisms involved in acute ischemic stroke in patients with COVID-19 infection have not been fully clarified. We prospectively studied the phenotypic and etiological features of acute stroke occurring in COVID-19 infection. PATIENTS & METHODS: Within nine months starting from April-2020, the presence of COVID-19 infection was determined by thoracic CT and SARS-CoV-2 PCR in all acute stroke cases managed in a single tertiary center. Consecutive and prospective data on vascular risk factors/comorbidities, in-hospital quality metrics, discharge outcomes, etiological subclassification and blood markers of thrombosis / inflammation were compared in 44 COVID-19 positive cases (37 acute ischemic stroke, 5 TIA, 2 intracerebral hematoma) and 509 COVID-19 negative patients (355 ischemic, 105 TIA, 44 hematoma and 5 stroke mimic). RESULTS: COVID-19 positive patients had more severe strokes, delayed hospital admission, longer hospital stay, higher mortality rates, but had similar vascular risk factors/comorbidities frequency, thrombolysis/thrombectomy utilization rates, metrics, and stroke etiological subtype. They had significantly higher CRP, fibrinogen, ferritin, leukocyte count and lower lymphocyte count. No difference was detected in aPTT, INR, D-dimer, platelet, hemoglobin, homocysteine levels and ANA, anti-dsDNA antibody and ENA panel positivity rates. Anti-phospholipid antibodies have been studied in 70% of COVID-19 positive and all cryptogenic patients, but were never found positive. Tests for coagulation factor levels and hereditary thrombophilia did not show major thrombophilia in any of the stroke patients with COVID-19. CONCLUSION: We documented that there is no significant difference in etiological spectrum in acute stroke patients with COVID-19 infection. In addition, cryptogenic stroke and antiphospholipid antibody positivity rates did not increase.


Subject(s)
COVID-19/complications , Hemorrhagic Stroke/etiology , Ischemic Attack, Transient/etiology , Ischemic Stroke/etiology , Aged , Aged, 80 and over , Biomarkers/blood , Blood Coagulation , COVID-19/diagnosis , COVID-19/therapy , COVID-19/virology , Case-Control Studies , Female , Hemorrhagic Stroke/diagnosis , Hemorrhagic Stroke/therapy , Humans , Inflammation Mediators/blood , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/therapy , Ischemic Stroke/diagnosis , Ischemic Stroke/therapy , Male , Middle Aged , Prognosis , Prospective Studies , Risk Assessment , Risk Factors
4.
Ann Vasc Surg ; 73: 122-128, 2021 May.
Article in English | MEDLINE | ID: covidwho-1118331

ABSTRACT

Carotid free-floating thrombus is an uncommon entity that usually presents with neurologic symptoms. Crescendo transient ischemic attack is an accepted indication for urgent carotid endarterectomy. COVID-19 is associated with severe thromboembolic complications. We report the case of a 61-year-old man who developed, 2 weeks after the diagnosis of COVID-19, crescendo transient ischemic attack, complicating a large intraluminal floating thrombus within the right common carotid artery. A carotid thromboendarterectomy under local anesthesia, with patch closure was immediately performed without complications. We conducted a literature review to identify cases of common carotid artery thrombus related to COVID-19. Carotid free-floating thrombus in the common carotid artery is exceptional. However, since the beginning of the COVID-19 pandemic, 15 cases have been published.


Subject(s)
COVID-19/complications , Carotid Artery Diseases/etiology , Carotid Artery, Common , Thrombosis/etiology , Adult , Aged , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/surgery , Carotid Artery, Common/diagnostic imaging , Computed Tomography Angiography , Endarterectomy, Carotid , Female , Humans , Ischemic Attack, Transient/etiology , Male , Middle Aged , Thrombosis/diagnostic imaging , Thrombosis/surgery , Ultrasonography
6.
Brain Behav Immun ; 88: 71-74, 2020 08.
Article in English | MEDLINE | ID: covidwho-599759

ABSTRACT

Corona Virus Disease 2019 (COVID-19) emerged in December 2019 from Wuhan, China. It typically presents with mild upper respiratory tract infection symptoms and may have life threatening complications, including acute respiratory distress syndrome, acute stroke, myocardial infarction, kidney failure, shock, and even death. Coronavirus infections are known to have neuroinvasive potential with consequent neuropsychiatric manifestations. We analyzed COVID-19 adult patients in the TriNetX database, which is a global health collaborative clinical research platform collecting real-time electronic medical records data from a network of health care organizations (HCOs) from January 20, 2020 to June 10th, 2020. 40,469 patients were diagnosed with COVID-19 among whom 9086 (22.5%) patients had neuropsychiatric manifestations. The most common neurologic manifestations included headache (3.7%) and sleep disorders (3.4%), Encephalopathy (2.3%), Stroke and transient ischemic attack (TIA) (1.0%) and 0.6% had seizures. Most common psychiatric manifestations included anxiety and other related disorders (4.6%), mood disorders (3.8%), while 0.2% patients had suicidal ideation. Early recognition and prompt management of neuropsychiatric manifestations in these patients have a potential to decrease overall morbidity and mortality.


Subject(s)
Coronavirus Infections/physiopathology , Coronavirus Infections/psychology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Ageusia/etiology , Anxiety/etiology , Anxiety/psychology , Betacoronavirus , Brain Diseases/etiology , COVID-19 , Coronavirus Infections/complications , Databases, Factual , Female , Headache/etiology , Humans , Ischemic Attack, Transient/etiology , Male , Middle Aged , Mood Disorders/etiology , Mood Disorders/psychology , Myalgia/etiology , Olfaction Disorders/etiology , Pain/etiology , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2 , Seizures/etiology , Sleep Wake Disorders/etiology , Stroke/etiology , Suicidal Ideation , Young Adult
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