We sought to describe a cohort of patients with COVID-19 infection and stroke attending a public hospital in Lima, Peru.

Although SARS-CoV-2 is primarily a respiratory disease, neurological symptoms have been reported to occur in one-third of patients with COVID-19. COVID-19 has been reported to pose an increased risk of stroke due to a hypercoagulable and pro-thrombotic state during the infection.

This was a prospective cohort study of patients hospitalized in a public tertiary care hospital in Lima, Peru who had a positive COVID-19 test and an acute neurological condition (i.e. stroke, encephalopathy, seizure) between May and October 2020. Demographic, clinical, laboratory testing and neuroimaging data were collected. Descriptive statistics were performed.

Of 40 participants that met inclusion criteria, 29/40 (72.5%) had a stroke (21/29 [72.4%] confirmed on neuroimaging and 8/29 [27.6%] had high clinical suspicion). The mean age was 62.3 +/- 14.0 years and 15/29 (51.7%) were female. Median hospitalization time from time of admission to time of discharge or death was 14 days (IQR: 7-26). Serological COVID test was obtained in 26/29 (89.7%).  25/27 (92.6%) had ischemic stroke, 11/27 (40.7%) of which were extensive infracts. Nearly half of those with stroke (14/29, 48.3%) had no COVID-related symptoms, and 9/19 (47.4%) had radiographic evidence of severe pneumonia. The following neurological symptoms were present: focal motor deficit (25/29, 86.2%), focal sensory deficit (8/29, 27.6%), headache (10/29, 34.5%), vertigo (4/29, 13.8%), decreased consciousness (19/29, 65.5%), ataxia (8/29, 27.6%), seizure (7/29, 24.1%), hypogeusia (5/29, 17.2%), hyposmia (7/29, 24.1%), visual disturbance (5/29, 17.2%). Only 2 patients were hospitalized in the ICU (2/29, 6.9%) and one-third of patients with stroke died during hospitalization (10/29, 34.5%).

Large ischemic stroke was a common complication among a small cohort of patients with neurological symptoms with COVID-19 infection.