Ischemic stroke during COVID-19 infection: a retrospective case series

Resumo

Background: COVID-19 affects the upper respiratory tract and can lead to organ injuries. The SARS-CoV-2 virus binds to angiotensin 2 receptors, highly expressed in pulmonary, endothelial, and nervous tissues. Ischemic Stroke (IS) is a major neurological complication, linked to coagulation disorders, endothelial dysfunction, and hyper-inflammatory responses. The purpose of this study is to characterize the clinical features of ischemic stroke occurring in patients with SARS-CoV-2 infection.

Material and Methods: A case-series study at Hospital das Clínicas, Faculty of Medicine of Marília, Brazil. The study analyzed 2013 medical records of COVID-19 patients hospitalized between 2020 and 2023, selecting 10 cases of acute ischemic stroke (AIS) during COVID-19 infection. Variables such as age, sex, risk factors, comorbidities, manifestations, severity, treatments, neuroimaging, and outcomes were analyzed Clinical outcomes were analyzed both quantitatively and qualitatively.

Results and discussion: Out of 2013 hospitalized patients, 10 (0.50%) had AIS. The mean age was 63 years, with 70% female. 60% were smokers, and 30% had a stroke history. Most (90%) had severe COVID-19, associated with hypertension, diabetes, dyslipidemia, atrial fibrillation, and prior cerebrovascular disease. 89% required high-flow oxygen, and 22% developed delirium. The average time from COVID-19 to stroke was 7.6 days. 60% of AIS cases had cardioembolic or undetermined etiology. 80% presented partial anterior circulation syndrome, with a 30% mortality rate.

Conclusions: The severity of these cases highlights the importance of rigorous risk factor management and thorough diagnostic investigation, underscoring the need for continuous monitoring and treatment strategies to optimize outcomes.