Only a few case series reporting a small number of stroke patients with COVID-19 have been published.1–5 We describe the characteristics of 19 consecutive strokes occurring in COVID-19-positive patients, admitted from 21 February to 28 April at the Guglielmo da Saliceto Hospital in Piacenza, one of the outbreak epicenters in Italy. Cases were identified retrospectively. Two cases (10.5%) were hemorrhagic and 17 (89.5%) ischemic. Mean age was 76.05 years (SD 8.83), 52.6% were male, mean National Institute of Health Stroke Scale (NIHSS) was 9.79 (SD 6.78). Stroke incidence among COVID-19 inpatients was 2.2%. Among the 19 cases, the risk factors were: diabetes 10.5%, hypertension 84.2%, and atrial fibrillation 31.6%. Fifteen patients had stroke onset during COVID-19; in four, it preceded COVID-19 diagnosis with a mean delay of −2.5 days (SD 1.0). Ischemic stroke etiologies were large artery atherosclerosis in four cases, cardioembolism in five, small vessel disease in two, and undetermined in six, of which two were ESUS. Three out of 17 ischemic strokes were treated with intravenous recombinant tissue plasminogen activator; these had a mean NIHSS 13.67 (SD 5.69). No hemorrhagic complications occurred, but one died and the other two had a modified Rankin Scale (mRS) score of 4 at discharge. Interstitial pneumonia was detected in 13 (68.4%) patients. Interstitial pneumonia severity was rated by the Visual-Well Aerated Lung (V-WAL) score, which is an index of COVID-19 evolution, when obtained at admission.6 The mean V-WAL score was 0.737 (SD 0.247). V-WAL correlated with admission NIHSS (r −0.635, r2 0.403, p 0.003) (Figure 1) and LDH levels (r −0.573, r2 0.328, p 0.01). Patients with interstitial pneumonia had higher NIHSS score (11.85 vs. 5.33 respectively, 95% CI 0.06–12.97, p 0.048) and greater disability at discharge (mRS 3–6 respectively, 57.9% vs. 10.5%, χ2 p 0.046). On multivariate analysis covarying for age, sex, diabetes, hypertension, cardiac failure, atrial fibrillation, obesity, delay between COVID-19 and stroke, LDH levels, NIHSS, mRS at discharge, and neoplasms, the association between NIHSS and V-WAL remained significant (p 0.046).
Stroke in COVID-19 patients—A case series from Italy / Immovilli, P., Terracciano, C., Zaino, D., Marchesi, E., Morelli, N., Terlizzi, E., De Mitri, P., Vollaro, S., Magnifico, F., Colombi, D., Michieletti, E., Guidetti, D.. - In: INTERNATIONAL JOURNAL OF STROKE. - ISSN 1747-4930. - 15:6(2020), pp. 701-702. [10.1177/1747493020938294]
Stroke in COVID-19 patients—A case series from Italy
Immovilli P.;Marchesi E.;Colombi D.;Guidetti D.
2020-01-01
Abstract
Only a few case series reporting a small number of stroke patients with COVID-19 have been published.1–5 We describe the characteristics of 19 consecutive strokes occurring in COVID-19-positive patients, admitted from 21 February to 28 April at the Guglielmo da Saliceto Hospital in Piacenza, one of the outbreak epicenters in Italy. Cases were identified retrospectively. Two cases (10.5%) were hemorrhagic and 17 (89.5%) ischemic. Mean age was 76.05 years (SD 8.83), 52.6% were male, mean National Institute of Health Stroke Scale (NIHSS) was 9.79 (SD 6.78). Stroke incidence among COVID-19 inpatients was 2.2%. Among the 19 cases, the risk factors were: diabetes 10.5%, hypertension 84.2%, and atrial fibrillation 31.6%. Fifteen patients had stroke onset during COVID-19; in four, it preceded COVID-19 diagnosis with a mean delay of −2.5 days (SD 1.0). Ischemic stroke etiologies were large artery atherosclerosis in four cases, cardioembolism in five, small vessel disease in two, and undetermined in six, of which two were ESUS. Three out of 17 ischemic strokes were treated with intravenous recombinant tissue plasminogen activator; these had a mean NIHSS 13.67 (SD 5.69). No hemorrhagic complications occurred, but one died and the other two had a modified Rankin Scale (mRS) score of 4 at discharge. Interstitial pneumonia was detected in 13 (68.4%) patients. Interstitial pneumonia severity was rated by the Visual-Well Aerated Lung (V-WAL) score, which is an index of COVID-19 evolution, when obtained at admission.6 The mean V-WAL score was 0.737 (SD 0.247). V-WAL correlated with admission NIHSS (r −0.635, r2 0.403, p 0.003) (Figure 1) and LDH levels (r −0.573, r2 0.328, p 0.01). Patients with interstitial pneumonia had higher NIHSS score (11.85 vs. 5.33 respectively, 95% CI 0.06–12.97, p 0.048) and greater disability at discharge (mRS 3–6 respectively, 57.9% vs. 10.5%, χ2 p 0.046). On multivariate analysis covarying for age, sex, diabetes, hypertension, cardiac failure, atrial fibrillation, obesity, delay between COVID-19 and stroke, LDH levels, NIHSS, mRS at discharge, and neoplasms, the association between NIHSS and V-WAL remained significant (p 0.046).I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
