Concurrent SARS-CoV-2 Infection is Associated with Higher Rates of Death or Disability at 90 Days in Stroke Patients – Analysis from a US Comprehensive Stroke Center

Abstract

Background— Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 infection is associated with
cerebrovascular events. Given the novelty of this viral illness, there is paucity of data regarding this association. We
aim to provide further evidence by reporting risk factors, clinical course and outcome in patients with SARS-CoV-2
infection presenting at our institute with cerebrovascular complications.
Methods— We extracted a cross-sectional analysis of data from our institutional HOPES stroke registry to
identify patients with SARS-CoV-2 infection who had cerebrovascular events. We analyzed the data and compared
demographics, laboratory, and clinical presentations across all stroke patients during the peak pandemic period.
Results— 22 patients with SARS-CoV-2 infection were treated at our medical center between March 2020 and
October 2020. Majority of these patient (~80%) suffered acute ischemic strokes while ~20% experienced intracra
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nial hemorrhage (ICH). We found that the majority of our cohort presented with neurological manifestations (77%)
prior to the respiratory illness, yet the cause of mortality was largely secondary to the pulmonary complications of
COVID-19 (56%). Patients with SARS-CoV-2 infection who suffered cerebrovascular events had a worse 90-day
outcome, as defined by the modified Rankin Scale score. Additionally, patients with SARS-CoV-2 infection who
received chemical or mechanical thrombolysis had higher rate of intracranial bleeding, with 5 of the 7 (71%) treated
patients dying during their hospitalization.
Conclusions— Neurological outcome appears to be worse in patients with SARS-CoV-2 infection when compared
to patients without SARS-CoV-2 infection experiencing cerebrovascular events.