Characteristics of ischemic stroke during the COVID-19 pandemic

Objectives: The study aimed to evaluate the effects of coronavirus disease 2019 (COVID-19) on stroke frequency and etiological features, as well as course and severity of stroke in patients with ischemic stroke. Patients and methods: A total of 262 patients with ischemic stroke [59 (36 males, 23 females; mean age: 66.5±12.7 years; range, 33 to 96 years) with COVID-19 infection (COVID-19 group) and 83 (57 males, 26 females; mean age: 67.3±12.9 years; range, 36 to 88 years) without COVID-19 infection (non-COVID-19 group)] during the pandemic and 120 patients (66 males, 54 females; mean age: 65.3±13.8 years; range, 39 to 92 years) with ischemic stroke before the pandemic period (pre-COVID-19 group) were evaluated retrospectively. Patients in the COVID-19 and non-COVID-19 groups were hospitalized between March 2020 and March 2021, whereas patients in the pre-COVID-19 group were hospitalized in 2019. Demographic data, clinical information, and risk factors for ischemic stroke were recorded. Detailed biochemical and cardiac evaluations, as well as cranial and vascular neuroimaging, were performed. The etiological diagnosis of stroke was decided according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. National Institutes of Health Stroke Scale (NIHSS) scores were calculated according to the neurological examinations at admission and the neurological examinations at discharge from the hospital. Results: Sex and age did not reveal significant differences between the three groups. The frequency of hypertension and diabetes mellitus did not reveal statistically significant differences between groups (p=0.5 and p=0.27, respectively). The frequency of hyperlipidemia was significantly higher in the COVID-19 group than in the pre-COVID-19 group (p=0.04). When etiology according to the TOAST classification was compared between the three groups, small vessel disease was detected significantly less frequently in the COVID-19 group than in the other two groups (p=0.02). The ratio of cardioembolic stroke in the COVID-19 group was higher than the other two groups. The difference did not achieve but approached statistical significance (p=0.06). The NIHSS scores at admission was compared with the NIHSS scores at discharge, and a statistically significant difference was obtained in all three groups. The NIHSS score at admission was significantly higher in the COVID-19 group than in pre-COVID-19 group (p=0.006). The difference between hospitalization and discharge NIHSS scores revealed a highly significant difference (p<0.001) when the COVID-19 group was compared with the non-COVID-19 group and the pre-COVID-19 group. Furthermore, the NIHSS score at discharge in the COVID-19 group was significantly higher than in the non-COVID-19 and pre-COVID-19 groups (p<0.001). Conclusion: Findings showed that COVID-19 was mostly caused by cardioembolic and cryptogenic etiology in patients with ischemic stroke. High NIHSS scores in the COVID-19 group suggests that COVID-19 deteriorated neurological findings, in addition to the general medical condition of the patients.