Abstract Details

Title Spectrum of Stroke Manifestations in COVID-19 Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 019

Objective The initial institutional experience in treatment of patients with COVID-19 and acute ischemic stroke (AIS) in Detroit, Michigan is presented.

Background Acute ischemic stroke (AIS) has been associated with COVID-19. Stroke care has been complicated due to delayed presentation and recognition.

Design/Methods Baseline demographic, clinical, and imaging data were retrospectively determined among patients with confirmed or suspected COVID-19 and AIS.

Results Eighteen patients with confirmed or suspected COVID-19 infection with AIS were identified from our cohort (mean age, 64.1 years; 56% women). Stroke onset was frequently delayed after COVID-19 symptoms (mean, 31 days; 50% presented >30 days). 94% had two or more vascular risk factors. Isolated encephalopathy was the lone presenting neurologic symptom in 33%. 50% were on anticoagulation (prophylactic and/or therapeutic) at the time of stroke onset, and CRP, D-dimer, and fibrinogen were consistently elevated. Infarcts involved multiple (56%), bilateral (44%), and/or large vascular territories (67%). Stroke mechanism was cardioembolic in 11%, other determined etiology in 6%, and cryptogenic or multiple in 83%. Outcomes were generally poor with few patients returning to independence and a 33% mortality (n=6).

Conclusions Most patients displayed abnormal coagulation laboratory measures and had multiple, bilateral and/or large vascular infarcts, despite anticoagulation, highlighting the potential intrinsic hypercoagulable and prothrombotic state of COVID-19. Although the rate of stroke in encephalopathic patients is undetermined, stroke should be strongly considered as a cause of encephalopathy in COVID-19 patients. Patients with a history of stroke may be at heightened risk for recurrent and increased severity of strokes. Sedation breaks for neurological exams, completion of stroke work, defining the timing and duration of anticoagulation and long term follow up should be strongly considered to improve patient outcome in the COVID-19 pandemic.

Authors/Disclosures
Jay L. Liu, DO (Parkview village apartment) PRESENTER	Dr. Liu has nothing to disclose.
Keval D. Shah, MD	Dr. Shah has nothing to disclose.
Amin Marji, MD	Dr. Marji has nothing to disclose.
Ayaz M. Khawaja, MD	Dr. Khawaja has nothing to disclose.

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Abstract Details