Acute Cerebrovascular Events With COVID-19 Infection

Mandip S. Dhamoon, MD, DrPH; Alison Thaler, MD; Kapil Gururangan, MD; Amit Kohli, MD; Daniella Sisniega, MD; Danielle Wheelwright, RN; Connor Mensching, MS; Johanna T. Fifi, MD; Michael G. Fara, MD, PhD; Nathalie Jette, MD, MSc; Ella Cohen, BS; Priya Dave, BA; Aislyn C. DiRisio, BS; Jonathan Goldstein, BA; Emma M. Loebel, BA; Naomi A. Mayman, BS; Akarsh Sharma, MS, BS; Daniel S. Thomas, BBA; Ruben D. Vega Perez, MPH; Mark R. Weingarten, BA; Huei Hsun Wen, MD, MSCR; Stanley Tuhrim, MD; Laura K. Stein, MD


Stroke. 2021;52(1):48-56. 

In This Article

Abstract and Introduction


Background and Purpose: Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known.

Methods: We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results.

Results: Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, P<0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal (P=0.02), parietal (P=0.002), occipital (P=0.002), and cerebellar (P=0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay (P<0.0001), greater percentage requiring intensive care unit care (P=0.017), and greater rate of neurological worsening during admission (P<0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, P<0.0001).

Conclusions: Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.


On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) a global pandemic.[1] New York State quickly became the epicenter of the US outbreak. As of early August, the total number of cases in New York State accounted for more than one-fifth of the United States caseload and surpassed that of any country besides the United States, Brazil, and Russia.[2,3] Within New York City, ≈204 000 cases were confirmed, over 52 000 patients were hospitalized, and over 20 000 patients died.[3,4]

COVID-19 has been associated with an increased incidence of thrombotic events, including severe cerebrovascular events in young patients.[5–7] However, some centers have reported a decline in acute cardiovascular and cerebrovascular cases and low rates of such events among hospitalized COVID-19 patients during the pandemic.[8–10] We sought to summarize the characteristics and short-term outcomes of patients admitted to a large multihospital health system in New York City with acute cerebrovascular disease during the COVID-19 pandemic. We hypothesized that patients with stroke and confirmed SARS-CoV-2 infection would have fewer traditional vascular risk factors, poorer outcomes, and an embolic or cryptogenic stroke cause more commonly than those without confirmed infection.