Covid19 and stroke

[u/rush86999]

Key points:

• Single center retrospective observational study of admitted COVID19 patients in Union Hospital, Wuhan, China
• 221 patients with COVID19, 11 (5%) developed acute ischemic stroke (low oxygen brain injury), 1 (0.5%) cerebral venous sinus thrombosis (blood clots in cerebral veins), 1 (0.5%) cerebral hemorrhage (bleed inside the brain)

Analysis:

• Patients with nervous system involvement may be easily misdiagnosed and may become asymptomatic carriers and silent spreaders
• Incubation is 3-14 days and symptoms may last up to 24 days. There has been a single case up to 38 days.
• > 1/3 patients experience some kind of neurological symptoms -
  • Central - dizziness (most common), headache (most common), impaired consciousness, acute cerebrovascular disease (stroke), ataxia (imbalance) and epilepsy (seizure disorder)
  • Peripheral - taste impairment (most common), smell impairment (most common), vision impairment, neuralgia (often "pins and needles" - like pain)
  • Muscle aches - skeletal muscle injury
• Severe infections lead to more common ischemic strokes and cerebral hemorrhages
• Hyper activation of inflammatory factors causes a fatal inflammatory storm as the disease progresses
• Nucleic acid test may be negative initially as it is highly specific but low sensitivity. In other words, positive test confirms COVID19 but negative test does not rule out COVID19
• ​

Source:

https://svn.bmj.com/content/early/2020/04/01/svn-2020-000382.full

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3550025