Characteristics of Ischemic Stroke in Symptomatic vs Asymptomatic COVID + Patients

ABSTRACT

INTRODUCTION Recent studies suggest that COVID-19 infection can predispose or even lead to ischemic stroke. The risk factors and characteristics of these strokes have yet to be defined. One large barrier to this type of analysis is the ability of physicians and researchers to separate strokes secondary to COVID-19 from primary stroke syndromes in the setting of asymptomatic and potentially non-contributory COVID-19 infection. Delineating between these two patient populations is essential both to defining and treating COVID-19 related stroke. METHODS Patients at 4 medical centers in NYC who tested positive for COVID-19 and had brain imaging consistent with acute ischemic stroke (AIS) were identified from the first 4 weeks of the city-wide lockdown. Symptomatic patients were defined based on symptoms and vital signs on admission. Baseline characteristics, risk factors, outcomes, stroke-subtypes, and imaging characteristics were all collected by retrospective chart review. RESULTS We identified 27 symptomatic and 14 non-symptomatic COVID-19 patients with AIS. There were no differences in baseline characteristics between the COVID-19 symptomatic and asymptomatic groups. The only difference in risk factors was that COVID-19 asymptomatic patients were more likely to be active smokers than COVID-19 symptomatic patients (P < .05). There were also no differences in stroke sub-type or stroke location between COVID-19 symptomatic and asymptomatic patients. Finally, there were no differences in mortality or functional outcomes between the two groups. CONCLUSION Our study suggests that there are no clear differences between the characteristics and outcomes of AIS in patients who are COVID-19 symptomatic vs asymptomatic. Larger studies are needed to determine if these similarities hold true. Additionally, better markers of systemic COVID-19 infection are needed to help delineate between COVID-19 and non-COVID-19 related strokes.