The spectrum of cerebrovascular events in COVID-19 patients in a racially and socioeconomically diverse patient population

ABSTRACT

Objective: To examine the breadth of cerebrovascular presentations in patients hospitalized with coronavirus disease 2019 (COVID-19) in a racially and socioeconomically diverse population. Background: COVID-19 has been associated with a significant risk for thrombotic events. Although reports suggest an increased number of cerebrovascular events in COVID-19 patients, most still had conventional vascular risk factors. Design/Methods: We conducted a retrospective, observational study of the incidence of cerebrovascular events and their mechanisms in all patients hospitalized with COVID-19 from April 15 to July 11 2020 at the largest academic safety net hospital in Boston, Massachusetts. Results: We identified 921 patients diagnosed with COVID-19;2.1% were found to have a cerebrovascular complication. 14 patients (1.5%) had confirmed ischemic stroke, 3 (0.3%) had hemorrhagic stroke, 2 (0.2%) had cerebral venous sinus thrombosis, and 2 (0.2%) had posterior reversible encephalopathy syndrome. Of all patients with cerebrovascular complications, the mean age was 64 years, 47% female, 53% male, with 16% identifying as White, 58% as African American and 26% as other. In regards to socioeconomic factors, 5% of patients were homeless, and 37% had Medicaid or low cost state funded insurance. Conventional stroke risk factors including hypertension were present in 53%, diabetes in 37%, tobacco use in 26%, hyperlipidemia in 16%, atrial fibrillation in 11% and 16% with history of a prior stroke. No identifiable risk factors were found in 21%. Of the ischemic stroke patients, the stroke mechanism was cardioembolic in 43%, small vessel disease in 7%, cryptogenic in 21.5%, stroke of other determined etiology in 21.5% and transient ischemic attack in 7%. Conclusions: We found that amongst the racially and socioeconomically diverse population at one large safety-net hospital, the rates of acute cerebrovascular events were low however varied in their presentations. Our patient population had fewer associated conventional vascular risk factors than typically observed in stroke patients.