Characteristics and outcomes of acute stroke in COVID-19 patients

Introduction: Acute cerebrovascular diseases are not uncommon in patients with COVID-19, especially those with pre-existing vascular risk factors.We aimed to report the clinical characteristics and outcomes of COVID-19 patients hospitalized for acute stroke.Methods: This cross sectional study included 23 patients with acute stroke among 11,914 COVID-19-infected patients admitted to Kepala Batas Hospital, Penang, between Jan 1, 2021 and March 31, 2023.The hospital serves as a COVID-19 hospital catering to over 1 million population in Penang mainland receiving referrals from hospitals and COVID-19 Assessment Centres.We extracted clinical histories, investigations, clinical management and outcomes from individual case notes; and performed descriptive analyses on selected variables.Results: The incidence of acute stroke in our cohort was 1.9 per 1,0 0 0 COVID-19 patients who required hospitalization.Among 23 patients, 60.9% were males with a mean age of 70.8 11.87 years.The majority (95.7%) were ischaemic strokes with one haemorrhagic stroke.One-fifth were recurrent strokes.The average NIHSS score was 6.7 at the presentation.Up to 87% have cardiovascularrelated comorbid, with 8.7% newly detected atrial fibrillation.Unilateral hemiparesis (60.9%), slurred speech (21.7%), and reduced consciousness (8.7%) were among the common presenting symptoms, in addition to fever and other respiratory symptoms.About 60.8% had mild COVID-19 infection while 39.1% had moderate-tosevere infection requiring oxygen supplementation.Only two received antiviral Paxlovid, one had baricitinib and one had monulpiravir.None were thrombolysed or underwent thrombectomy.Their average length of hospitalization was 6.1 days.About 26.1% had a door-to-CT scan for more than 4.5 hours.Approximately 82% patients were discharged with antiplatelet and/or anticoagulant.Inpatient mortality was 17.4%. Conclusion:Our stroke cohort composed of older persons with vascular risk factors and high mortality.COVID-19 infection complicates acute stroke care with the isolation protocol.With an evolving understanding of stroke in COVID-19, we can further optimize stroke care.