Department of Neurology, University of Pennsylvania, Philadelphia.
Stroke. 2020 Sep;51(9):e219-e222. doi: 10.1161/STROKEAHA.120.030995. Epub 2020 Jul 20.
Initial reports suggest a significant risk of thrombotic events, including stroke, in patients hospitalized with coronavirus disease 2019 (COVID-19). However, there is little systematic data on stroke incidence and mechanisms, particularly in racially diverse populations in the United States.
We performed a retrospective, observational study of stroke incidence and mechanisms in all patients with COVID-19 hospitalized from March 15 to May 3, 2020, at 3 Philadelphia hospitals.
We identified 844 hospitalized patients with COVID-19 (mean age 59 years, 52% female, 68% Black); 20 (2.4%) had confirmed ischemic stroke; and 8 (0.9%) had intracranial hemorrhage. Of the ischemic stroke patients, mean age was 64 years, with only one patient (5%) under age 50, and 80% were Black. Conventional vascular risk factors were common, with 95% of patients having a history of hypertension and 60% a history of diabetes mellitus. Median time from onset of COVID symptoms to stroke diagnosis was 21 days. Stroke mechanism was cardioembolism in 40%, small vessel disease in 5%, other determined mechanism in 20%, and cryptogenic in 35%. Of the 11 patients with complete vascular imaging, 3 (27%) had large vessel occlusion. Newly positive antiphospholipid antibodies were present in >75% of tested patients. Of the patients with intracranial hemorrhage, 5/8 (63%) were lobar intraparenchymal hemorrhages, and 3/8 (38%) were subarachnoid hemorrhage; 4/8 (50%) were on extracorporeal membrane oxygenation.
We found a low risk of acute cerebrovascular events in patients hospitalized with COVID-19. Most patients with ischemic stroke had conventional vascular risk factors, and traditional stroke mechanisms were common.
最初的报告表明，患有 2019 年冠状病毒病（COVID-19）的住院患者发生血栓栓塞事件（包括中风）的风险显著增加。然而，在美国，关于中风发病率和发病机制的系统数据很少，尤其是在种族多样化的人群中。
我们对 2020 年 3 月 15 日至 5 月 3 日期间，3 家费城医院收治的所有 COVID-19 住院患者的中风发病率和发病机制进行了回顾性、观察性研究。
我们共确定了 844 例 COVID-19 住院患者（平均年龄 59 岁，52%为女性，68%为黑人）；其中 20 例（2.4%）确诊为缺血性中风，8 例（0.9%）发生颅内出血。缺血性中风患者的平均年龄为 64 岁，仅有 1 例（5%）年龄小于 50 岁，80%为黑人。常见的传统血管危险因素，95%的患者有高血压病史，60%有糖尿病病史。从 COVID 症状发作到中风诊断的中位时间为 21 天。中风机制为心源性栓塞占 40%，小血管疾病占 5%，其他确定机制占 20%，隐源性占 35%。在 11 例完成血管影像学检查的患者中，3 例（27%）存在大血管闭塞。超过 75%的检测患者新出现抗磷脂抗体阳性。8 例颅内出血患者中，5/8（63%）为脑叶实质内出血，3/8（38%）为蛛网膜下腔出血；4/8（50%）在体外膜肺氧合。
我们发现 COVID-19 住院患者发生急性脑血管事件的风险较低。大多数缺血性中风患者有传统的血管危险因素，常见的传统中风机制。
