Patients Presenting with Acute Stroke During COVID-19 Pandemic Era: A Multicenter Retrospective Study

Abstract

Background Coronavirus disease-2019 (COVID-19) infection originated in China and was very quickly seen in the Middle East North Africa (MENA) region. This study was undertaken to evaluate COVID-19-related cerebrovascular involvement in the MENA+ region. Methods Retrospective observational regional multicenter study aiming to identify acute stroke presentation and functional independency in patients with COVID-19 infection in the MENA region. The diagnosis of COVID-19 was established by polymerase chain reaction testing in all patients. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke symptoms. Functional independency was assisted by a modified Rankin Scale (mRS) at 90 days. Results There were 209 patients including 65 COVID-19-related stroke group (CRSG). The mean age was 62.85 ± 15.94 for (CRSG) and 58.69 ± 14.73 in non-COVID-19 stroke group (NCSG). The most prevalent risk factor for both groups was hypertension 45 (69.2%) and 105 (72.9) respectively. Intravenous thrombolysis therapy was delivered to 6/65 (9.2%) in (CRSG) compared to 11 (7.6) in (NCSG). The mean NIHSS at baseline for the (CRSG) was 12.94 ± 9.46, versus 6.08 ± 4.9 in (NCSG). This was statistically significant ( P < 0.001). Functional outcome at the 90-day measured using mRS was worse in the (CRSG) compared to (NCSG) 3.61 ± 2.53, 2.20 ± 2.60 respectively and this was statistically significant ( P = 0.001). Conclusion In this study from multiple countries from the MENA+ region, we showed that acute stroke in patients with active COVID-19 had more severe symptoms at onset and worse 90 days’ outcomes despite the young age. There were no regional differences noted in severity and outcome in the MENA region.