Characteristics and clinical course of Covid-19 patients admitted with acute stroke
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LETTER TO THE EDITORS
Characteristics and clinical course of Covid‑19 patients admitted with acute stroke Lucio D’Anna1,2 · Joseph Kwan1 · Zoe Brown1 · Omid Halse1 · Sohaa Jamil1 · Dheeraj Kalladka1 · Marius Venter1 · Soma Banerjee1,2 Received: 19 May 2020 / Revised: 16 June 2020 / Accepted: 18 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Sirs, Covid-19 infection has been associated with a predominant prothrombotic state causing venous and arterial thrombosis [1]. Although cerebrovascular complications were reported in 0.8% and in 5.7% of the patients with non-severe and severe Covid-19 disease [2], respectively, they were associated with 2.5-fold increased odds of severe disease in patients with Covid-19 infection [3]. Previous case reports or case series described patients with Covid-19 infection who developed acute stroke [4–12]. Here, we describe the clinical features, neuroimaging and laboratory findings of a case series of patients with Covid-19 infection consecutively admitted to our hyperacute stroke unit (HASU), Charing Cross Hospital, Imperial College Health Care NHS Trust (ICHT) with acute stroke via the acute stroke pathway. From the 1 March to 30 April 2020, eight acute stroke patients who tested positive for Covid-19 were consecutively admitted to our HASU. Seven out of eight patients suffered an ischemic stroke, with one patient with a haemorrhagic stroke. The median age of our patients was 74 years old (IQR 11.8), and the median NIHSS on admission was 8.5 (IQR 6.3) (Table 1). Our patients developed the symptoms of stroke after a median interval time of 7 days (IQR 10.5) after the onset of their Covid-19 infection. Of note, three patients Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-10012-4) contains supplementary material, which is available to authorized users. * Lucio D’Anna [email protected] 1
Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, Fulham Palace Road, London W6 8RF, UK
Department of Brain Sciences, Imperial College London, London, UK
2
out of eight showed the neurological symptoms of stroke at the same time as the symptoms of the Covid-19 infection. In the seven patients with ischemic stroke, the majority were in the anterior circulation (n = 6). Large vessel occlusion or floating thrombus in a large vessel was seen in three patients (Fig. 1). Multiple ischemic infarcts were documented in 5 cases out of 7 of which three patients had bilateral lesions. The size of the infarct was classified as small in four cases [13]. One patient (no. 7) was treated successfully with intravenous thrombolysis with tissue plasminogen activator (t-PA) at 3 h and 15 min after the onset of his symptoms. After 24 h, his NIHSS dropped from 8 to 3 and he was discharged after three days with no neurological symptoms and being functionally independent (mRs 0). Table 2 shows the laboratory and radiologic findings on admission for our patients. M
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