Department of Neurology, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, GA, United States of America.
Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States of America.
PLoS One. 2020 Sep 18;15(9):e0239443. doi: 10.1371/journal.pone.0239443. eCollection 2020.
In the setting of the Coronavirus Disease 2019 (COVID-19) global pandemic caused by SARS-CoV-2, a potential association of this disease with stroke has been suggested. We aimed to describe the characteristics of patients who were admitted with COVID-19 and had an acute ischemic stroke (AIS).
This is a case series of PCR-confirmed COVID-19 patients with ischemic stroke admitted to an academic health system in metropolitan Atlanta, Georgia (USA) between March 24th, 2020 and July 17th, 2020. Demographic, clinical, and radiographic characteristics were described.
Of 396 ischemic stroke patients admitted during this study period, 13 (2.5%) were also diagnosed with COVID-19. The mean age of patients was 61.6 ± 10.8 years, 10 (76.9%) male, 8 (61.5%) were Black Americans, mean time from last normal was 4.97 ± 5.1 days, and only one received acute reperfusion therapy. All 13 patients had at least one stroke-associated co-morbidity. The predominant pattern of ischemic stroke was embolic with 4 explained by atrial fibrillation. COVID-19 patients had a significantly higher rate of cryptogenic stroke than non-COVID-19 patients during the study period (69% vs 17%, p = 0.0001).
In our case series, ischemic stroke affected COVID-19 patients with traditional stroke risk factors at an age typically seen in non-COVID populations, and mainly affecting males and Black Americans. We observed a predominantly embolic pattern of stroke with a higher than expected rate of cryptogenic strokes, a prolonged median time to presentation and symptom recognition limiting the use of acute reperfusion treatments. These results highlight the need for increased community awareness, early identification, and management of AIS in COVID-19 patients.
在由 SARS-CoV-2 引起的 2019 年冠状病毒病（COVID-19）全球大流行背景下，有研究提示这种疾病与中风之间可能存在关联。本研究旨在描述因 COVID-19 住院且患有急性缺血性脑卒中（AIS）的患者的特征。
这是一组在佐治亚州亚特兰大市一家学术医疗系统内住院的经 PCR 确诊的 COVID-19 合并缺血性脑卒中患者的病例系列研究，研究期间为 2020 年 3 月 24 日至 2020 年 7 月 17 日。描述了患者的人口统计学、临床和影像学特征。
在这段研究期间，共 396 例缺血性脑卒中患者住院，其中 13 例（2.5%）同时被诊断患有 COVID-19。患者的平均年龄为 61.6±10.8 岁，10 例（76.9%）为男性，8 例（61.5%）为美国黑人，末次正常时间至发病的平均时间为 4.97±5.1 天，仅 1 例接受了急性再灌注治疗。所有 13 例患者均至少合并 1 种与脑卒中相关的共病。缺血性脑卒中的主要模式为栓塞性，其中 4 例由心房颤动引起。在研究期间，COVID-19 患者的隐源性脑卒中发生率明显高于非 COVID-19 患者（69%比 17%，p=0.0001）。
在我们的病例系列中，缺血性脑卒中影响了具有传统脑卒中危险因素的 COVID-19 患者，这些患者的年龄与非 COVID 人群中常见的年龄相仿，主要影响男性和美国黑人。我们观察到以栓塞性脑卒中为主的模式，隐源性脑卒中的发生率高于预期，中位发病至就诊时间较长，症状识别延迟，限制了急性再灌注治疗的应用。这些结果强调了需要提高社区意识，早期识别和管理 COVID-19 患者的 AIS。
