Ischemic stroke and COVID-19 infection — a review of clinical case reports

Abstract

Abstract Background Despite the availability of vaccines, COVID-19 remains of global concern with seasonal peak in cases across the globe and considering its link to brain pathologies such as stroke. Our aim was to characterize the presence of comorbidities and how the time of COVID-19 infection relative to stroke onset impacts outcomes. Methods We reviewed 68 cases of COVID-19 in hospitalized patients with acute stroke. We searched for published case reports using PubMed and Google Scholar limited to publications written in English from September 2019 to December 2022. We excluded systematic reviews from our search result and categorized individual cases into four groups: COVID-19-induced stroke (CIS, those who had COVID-19 shortly before stroke onset), stroke then COVID-19 (STC, those who had COVID-infection immediately following stroke onset), COVID-19 and stroke (CAS, those who presented with both stroke and COVID-19 infection). The following information was extracted and analyzed from included search reports: age, NIHSS score, type of stroke, mortality, functional outcomes, and comorbidities listed. Conclusions Most patients who were reported for admission stroke were of middle age, and only more aged individuals presented with concurrent stroke onset and COVID-19 infection. Hypertension was the most prevalent comorbidity across all four groups, especially among the STC group. The poorest functional outcomes and highest inhospital mortality were observed among the STC group when compared to other groups. The concurrent presentation of stroke and COVID-19 infection had the least impact on functional outcome, but COVID-19 infection during acute stroke hospitalization may worsen clinical outcomes especially among individuals with hypertension.