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Large-Vessel Stroke as a Presenting Feature of COVID-19 in the Young

Our take —

Emerging evidence suggests that coagulopathy and vascular dysfunction are a significant complications of COVID-19. This small study provides clinical and laboratory characterizations of 5 COVID-19 patients less than 50 years old who presented with large-vessel ischemic stroke. This exploratory evidence of the association between COVID-19 and stroke among younger patients warrants further examination.

Study design

Case Series

Study population and setting

This is a case series of five patients with laboratory-confirmed SARS-CoV-2 infection who were less than 50 years of age, experienced new symptoms of large-vessel ischemic stroke and were admitted to the Mount Sinai Health System in New York City between March 23 and April 7, 2020. For reference, during each two-week period over the previous 12 months, the same hospital treated an average of only 0.73 patients younger than 50 years of age who presented with large-vessel stroke.

Summary of Main Findings

The patients ranged in age from 33-49 years (80% male). The two youngest patients had no medical history or risk factors for stroke; the other three had underlying comorbidities, including hypertension and diabetes. One patient had a history of stroke. The mean National Institutes of Health Stroke Scale (NIHSS) score upon admission was 17.  Two patients were discharged to rehabilitation facilities; one was discharged to home; and two remained in the hospital by the end of the study period. Two patients reported delays in going to the hospital because of the pandemic.

Study Strengths

Patient presentations were well characterized, including pertinent laboratory findings, imaging findings, and treatments provided.

Limitations

The study population includes a small number of patients from a single hospital in New York City, and is limited to critical presentations.

Value added

This is one of the first studies to describe presentations of severe large-vessel stroke among young (<50 years old), laboratory-confirmed COVID-19 patients in a US care setting. It also suggests that concern about going to the hospital during a pandemic may delay people from seeking care.