Risk Factors, and Clinical and Etiological Characteristics of Ischemic Strokes in COVID-19-Infected Patients: A Systematic Review of Literature

Background and Purpose: Coronavirus disease 2019 (CO-VID-19) infection is an ongoing pandemic and worldwide health emergency that has caused important changes in healthcare systems. Previous studies reported an increased risk of thromboembolic events, including stroke. This systematic review aims to describe the clinical features and etiological characteristics of ischemic stroke patients with CO-VID-19 infection. Method: A literature search was performed in principal databases for studies and case reports containing data concerning risk factors, clinical features, and etiological characteristics of patients infected with COVID-19 and suffering from stroke. Descriptive and analytical statistics were applied. Results: Overall, 14 articles were included for a total of 93 patients. Median age was 65 (IQR: 55-75) years with prevalence in males. Stroke occurred after a median of 6 days from COVID-19 infection diagnosis. Median National of Institute of Health Stroke Scale (NIHSS) score was 19. Cryptogenic (Cry) strokes were more frequent (51.8%), followed by cardioembolic etiology, and they occurred a long time after COVID-19 diagnosis compared with large-artery atherosclerosis strokes (p(trend): 0.03). The clinical severity of stroke was significantly associated with the severity grade of COVID-19 infection (p(trend): 0.03). Conclusions: Ischemic strokes in COVID-19-infected patients were clinically severe, affecting younger patients mainly with Cry and cardioembolic etiologies. Further multicenter prospective registries are needed to better describe the causal association and the effect of COVID-19 infection on stroke.

Automated summary

This systematic review aimed to describe the clinical features and etiological characteristics of ischemic stroke patients with COVID-19 infection. The study included 93 patients with a median age of 65 years, predominantly male, and with a median National Institute of Health Stroke Scale score of 19. Cryptogenic strokes were the most common etiology, occurring a long time after COVID-19 diagnosis compared to other types of strokes. The severity of stroke was significantly associated with the severity grade of COVID-19 infection. Further research is needed to better understand the causal relationship and impact of COVID-19 infection on stroke.