COVID-19 has affected access to healthcare.  Due to travel restrictions and fear of COVID-19 infection, people avoided visiting hospitals during COVID-19 pandemic. 

After IRB approval, admission data, clinical characteristics, and management of patients admitted to King Abdulaziz Medical City, MNGHA, Riyadh, KSA were analyzed. 

A total of 105 patients were admitted between March 1, 2020 to June 30, 2020, with average of 26 admissions per month.  In 2019, average admissions were 44 per month.  Of the 105 patients, 69 (66%) were men.  Mean age was 59.6 +/-13.3 years, 85 (81%) were Saudis.  Majority, 62 (60%) of the patients presented after 6 hours of symptoms onset.  Ischemic stroke or TIA was seen in 89 (85%) patients.  Large vessel disease was seen in 25 (28%) patients, small vessel disease in 26 (29%), whereas stroke was of undetermined etiology in 23 (26%).  Hypertension was the commonest vascular risk factors in 84 (80%) patients, followed by diabetes and ischemic heart disease in 65 (62%) and 18 (17%) respectively.

Only 6 (6%) patients tested positive for COVID-19, of whom 5 were non-Saudis (p=<0.001).  Stroke code was activated on 40 (38%), with mean time of 9.4 minutes.  Intravenous thrombolysis and endovascular thrombectomy was performed in 5 (5%) patients each.  Prior to this period, the rate of intravenous thrombolysis was about 12%.  Mean door-to-needle (DTN) time was 63 +/- 22 minutes, whereas in 2019, it was 55 minutes.

During peak months of COVID-19 in Saudi Arabia, monthly stroke admissions decreased by almost 40%, most patients presented after 6 hours of symptoms onset, fewer patients underwent intravenous thrombolysis or endovascular thrombectomy.  There was slight increase in mean DTN time during this period.