By Denise Baez
Coronavirus disease 2019 (COVID-19) infection is independently associated with acute ischaemic stroke, according to a study published in American Journal of Neuroradiology.
The findings suggest that patients with COVID-19 should undergo more aggressive monitoring for stroke.
“To our knowledge, this is the first study to link SARS-CoV-2 with an increased risk of imaging-confirmed acute ischaemic stroke when accounting for confounding risk factors,” wrote Puneet Belani, MD, Icahn School of Medicine at Mount Sinai, and Mount Sinai Hospital, New York, and colleagues. “Patients with COVID-19 should be evaluated early for acute neurologic changes, and timely work-up should be performed in patients suspected of having stroke to reduce morbidity and mortality.”
Dr. Belani and colleagues analysed data from patients who underwent imaging for suspected stroke due to hemiplegia, hemisensory loss, dysarthria, facial droop, aphasia, and acute altered mental status between March 16, 2020, and April 5, 2020, at 6 hospitals across New York City.
They matched patients with confirmed acute stroke on imaging (n = 41) with patients who had no evidence of acute infarction (n = 82) for age, sex, and vascular risk factors. Sex composition was identical between groups, with 56.1% men in each.
Of the patients with confirmed acute ischaemic stroke, 46.3% had COVID-19 infection compared with 18.3% of controls (P = 0.001). After adjusting for age, sex, and risk factors, COVID-19 infection had a significant independent association with acute ischaemic stroke compared with control subjects (odds ratio = 3.9; 95% confidence interval, 1.7-8.9; P = 0.001).
“Limitations of our study are those that apply to all retrospective case-control studies,” the authors wrote. “We tried to limit confounding variables like demographics and medical risk factors for stroke to reduce bias. We reduced referral bias by incorporating stroke alert cases from multiple hospitals across various communities in New York City. Another limitation is our sample size of 123 patients; however, these are all patients with stroke alerts presenting at 6 hospitals, which consisted of 1 large academic hospital and 5 smaller community hospitals, during a short time span of 2.5 weeks.”
“Future endeavours may assess whether this relationship holds true in a larger population and with the pathophysiologic mechanisms inherent in COVID-19 that drive this association,” they concluded. “Attempts should also be made to see whether the association holds true for large-vessel and small-vessel strokes.”