CEREBROVASCULAR DISEASES IN PATIENTS WITH SARS-COV-2 INFECTION: A NATIONAL SERIES

ABSTRACT

Background and aims: There is a higher incidence of cerebrovascular disease (CVD) in patients with SARS-CoV-2 infection. We aim to describe a national series of CVD in patients with confirmed SARS-CoV-2 infection. Methods: Fourteen Brazilian Stroke Centers registered clinical, neuroimaging and laboratory findings from April to November 2020. Results: We included 344 patients in the final analysis. Age ranged from 20-95 (median 57[57, 75] years). Cerebral ischemia (CI) occurred in 83.7%(n=288), intraparenchymal hemorrhage (IPH) 6.7%(n=23), central venous thrombosis (CVT) 5.2%(n=18) and subarachnoid hemorrhage (SAH) 4.4% (n=15). CVD was the first symptom of SARS-CoV-2 in 37.8% of cases - among those with SAH, 60% had no systemic symptoms. CI cases had higher values of Dimer-D compared to others. Involvement of at least two arterial territories occurred in 13.8%. Among IPH patients, 25% were under anticoagulation with heparin. Patients with SAH had a spontaneous etiology in 35.7%. Dimer-D levels at admission were associated with worse outcomes (mRS3-6) (OR1.14, 95%CI1.008-1.29, p=0.03), in an adjusted analysis. The time of onset of neurological symptoms (TONS) since SARS-CoV-2 infection was indirectly related to neurological severity at admission (-0.17, p=0.04,). In-hospital treatment with corticosteroids was associated with in-hospital encephalopathy (OR2.5,95%CI 1.01-6.16,p=0.04). Poor outcome (mRS3-5) occurred in 54.1% of cases. Conclusions: Patients with CVD and SARS-CoV-2 are at higher risk of unfavorable outcomes. The TONS since infection is related to neurologic severity;and serum Dimer-D levels may be useful for prognostication. The higher prevalence of non-aneurysmal SAH cases suggests pathophysiological mechanisms other than a hypercoagulable state.