Cited by 711Long-Term Effects of COVID-19COVID-19 Clinical Research StudiesAcute Ischemic Stroke Management

Characteristics of ischaemic stroke associated with COVID-19

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Beyrouti, Rahma, Adams, Matthew E, Benjamin, Laura, Cohen, Hannah, Farmer, Simon F, Goh, Yee Yen, Humphries, Fiona, Jäger, Hans Rolf +7 more·2020·Journal of Neurology, Neurosurgery & Psychiatry

Abstract

Characteristics of ischaemic stroke associated with COVID-19Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with coagulopathy causing venous and arterial thrombosis. 1 2 Recent data from the pandemic epicentre in Wuhan, China, reported neurological complications in 36% of 214 patients with COVID-19; acute cerebrovascular disease (mainly ischaemic stroke) was more common among 88 patients with severe COVID-19 than those with nonsevere disease (5.7% vs 0.8%).3 However, the mechanisms, phenotype and optimal management of ischaemic stroke associated with COVID-19 remain uncertain.We describe the demographic, clinical, radiological and laboratory characteristics of six consecutive patients assessed between 1 st and 16 th April 2020 at the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, with acute ischaemic stroke and COVID-19 (confirmed by reverse-transcriptase PCR (RT-PCR)) (table 1).All six patients had large vessel occlusion with markedly elevated D-dimer levels (≥1000μg/L).Three patients had multiterritory infarcts, two had concurrent venous thrombosis, and, in two, ischaemic strokes occurred despite therapeutic anticoagulation.

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Crossref · 10.1136/jnnp-2020-323586

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  • Many neurological symptoms associated with CoV-2 infection, such as stroke or altered consciousness, are consistent with underlying vasculopathy.

    “Multiple immunostaining studies reveal that ACE2 protein in the human brain is predominantly or exclusively expressed in vasculature (and specifically expressed within pericytes) (52, 53, 70), and many neurological symptoms associated with CoV-2 infection like stroke or altered consciousness are consistent with an underlying vasculopathy (71-76).”

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Authors
Beyrouti, R., Adams, M. E., Benjamin, L., Cohen, H., Farmer, S. F., Goh, Y. Y., Humphries, F., Jäger, H. R., Losseff, N. A., Perry, R. J., Shah, S., Simister, R. J., Turner, D., Chandratheva, A., & Werring, D. J.
Affiliations
  • University College London Hospitals NHS Foundation Trust (GB)
  • University of Liverpool (GB)
  • University College London (GB)
Corresponding author
Werring, David J
Venue
Journal of Neurology, Neurosurgery & Psychiatry
Publisher
BMJ
Published
2020-04-30
Volume
91
Issue
8
Pages
889-891
ISSN
  • 0022-3050 (ISSN-L)
  • 1468-330X
OpenAlex
W3022807497
Cited by
711
References
5
Citations by year
2026: 3 · 2025: 14 · 2024: 32 · 2023: 40 · 2022: 117 · 2021: 253 · 2020: 250 · 2012: 1
FWCI
71.40
Type
journal article
Language
en
Open access
Locations
  • Journal of Neurology Neurosurgery & Psychiatry (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
COVID-19 pandemic, SARS-CoV-2, ischemic stroke, large vessel occlusion, D-dimer, coagulopathy, venous thrombosis, anticoagulation failure, neurological complications of COVID-19, stroke features
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, Aged, Aged, 80 and over, Brain Ischemia, Female, Humans, Male, Middle Aged, Pneumonia, Viral, Coronavirus Infections, Stroke, Pandemics

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