Bihemispheric Ischemic Strokes in Patients With COVID-19

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

10-2021

DOI

10.1016/j.jns.2021.119901

Journal Title

Journal of the Neurological Sciences

Department

Neurosurgery

Second Department

Neurology

Third Department

Radiology

Abstract

Background and aims

There is emerging evidence that COVID-19 can trigger thrombosis because of a hypercoagulable state, including large vessel occlusion ischemic strokes. Bi-hemispheric ischemic stroke is uncommon and is thought to indicate an embolic source.

Methods

We performed a retrospective cohort study at a quaternary academic medical center between March 1st and April 30th, 2020. We identified all patients with laboratory-confirmed SARS-CoV-2 infection who presented with simultaneous bi-hemispheric ischemic strokes.

Results

Of 637 COVID-19 admissions during the two-month period, 13 had a diagnosis of acute ischemic stroke, including 5 who developed with bi-hemispheric cerebral infarction. Three (60%) were female, median age was 54 (range 41–67), and all five were being managed for severe COVID-19 related pneumonia complicated by acute kidney injury and liver failure before the diagnosis of cerebral infarction was established. Five presented with elevated ferritin, lactate dehydrogenase, and interleukin-6 (IL-6) levels, and four had lymphopenia and elevated D-dimer levels. All patients underwent neuroimaging with CT for persistent depressed mentation, with or without a focal neurologic deficit, demonstrating multifocal ischemic strokes with bi-hemispheric involvement. Outcome was poor in all patients: we discharged two to a rehabilitation facility with moderate-to-severe disability, and three (60%) patients died.

Conclusions

Stroke is implicated in SARS-CoV-2 infection. Multifocal ischemic strokes with bi-hemispheric involvement should be considered in COVID-19 patients with severe infection and poor neurologic status and may be associated with poor outcomes.

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