Acute Ischemic Stroke During the Convalescent Phase of Asymptomatic COVID-2019 Infection in Men

22, April 2021 |

Authors:

Abstract

MPORTANCE Acuteischemicstroke(AIS)isaknownneurologicalcomplicationinpatientswith respiratory symptoms of COVID-19 infection. However, AIS has not been described as a late sequelae in patients without respiratory symptoms of COVID-19. OBJECTIVE ToassessAISexperiencedbyadults50yearsoryoungerintheconvalescentphaseof asymptomatic COVID-19 infection. DESIGN,SETTING,ANDPARTICIPANTS Thiscaseseriesprospectivelyidentifiedconsecutivemale patients who received care for AIS from public health hospitals in Singapore between May 21, 2020, and October 14, 2020. All of these patients had laboratory-confirmed asymptomatic COVID-19 infection based on a positive SARS-CoV-2 serological (antibodies) test result. These patients were individuals from South Asian countries (India and Bangladesh) who were working in Singapore and living in dormitories. The total number of COVID-19 cases (54 485) in the worker dormitory population was the population at risk. Patients with ongoing respiratory symptoms or positive SARS- CoV-2 serological test results confirmed through reverse transcriptase–polymerase chain reaction nasopharyngeal swabs were excluded. MAINOUTCOMESANDMEASURES Clinicalcourse,imaging,andlaboratoryfindingswere retrieved from the electronic medical records of each participating hospital. The incidence rate of AIS in the case series was compared with that of a historical age-, sex-, and ethnicity-matched national cohort. RESULTS Atotalof18malepatients,withamedian(range)ageof41(35-50)yearsandSouthAsian ethnicity, were included. The median (range) time from a positive serological test result to AIS was 54.5 (0-130) days. The median (range) National Institutes of Health Stroke Scale score was 5 (1-25). Ten patients (56%) presented with a large vessel occlusion, of whom 6 patients underwent intravenous thrombolysis and/or endovascular therapy. Only 3 patients (17%) had a possible cardiac source of embolus. The estimated annual incidence rate of AIS was 82.6 cases per 100 000 people in this study compared with 38.2 cases per 100 000 people in the historical age-, sex-, and ethnicity- matched cohort (rate ratio, 2.16; 95% CI, 1.36-3.48; P < .001). CONCLUSIONSANDRELEVANCE ThiscaseseriessuggeststhattheriskforAISishigherinadults 50 years or younger during the convalescent period of a COVID-19 infection without respiratory symptoms. Acute ischemic stroke could be part of the next wave of complications of COVID-19, and stroke units should be on alert and use serological testing, especially in younger patients or in the absence of traditional risk factors.