Cerebrovascular Manifestations of COVID-19 in Young Adults

ABSTRACT

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.