We aimed to characterize patients with COVID-19 and stroke and compare outcomes with patients with stroke only in the hospital setting.

COVID-19 infection is associated with a hypercoagulable state which results in thrombotic events, such as ischemic stroke. However, few studies have reported patient outcomes based on the primary presentation (COVID-19 or stroke first), and the association between COVID-19 and hemorrhagic stroke in the hospital setting.

We retrospectively reviewed and characterized all patients (N=66) who were COVID-19 positive at the time of ischemic or hemorrhagic presentation to a tertiary medical center between March 2020 and December 2020. This cohort was compared with patients who were COVID-19 negative at the time of stroke presentation in the same period (N=537). Statistical significance was evaluated using Pearson’s Chi-squared test with Yates’ continuity correction.

The mean age of stroke patients with COVID-19 was 62.1 years old with 62.1% identified as male and 37.9% as female, which is similar to the cohort without COVID-19 (mean age=64.7). Of the COVID-19 positive patients, multiple comorbidities were identified including hypertension (68.2%), diabetes mellitus (56.1%), and hyperlipidemia (36.4%). 22 (33.4%) patients initially presented with stroke and 44 (66.7%) initially presented with COVID-19. Overall mortality was 37.9% with 36.4% in the stroke-first cohort and 38.6% in the COVID-first cohort. This is significantly higher than patients who had a stroke only (17.3%, p<0.001). In the stroke-first cohort, 22.7% patients presented with a hemorrhagic stroke and 77.2% with an ischemic stroke. In the COVID-first cohort, 38.6% experienced a hemorrhagic stroke while 61.4% had an ischemic stroke with similar mortality rates.

In the early pandemic, we found that patients with COVID-19 infection and stroke, regardless of the primary presentation, had a higher mortality rate than patients with only stroke. Mortality rates were similar between patients with a hemorrhagic stroke and an ischemic stroke.