This study examines differences in acute stroke presentations and outcomes before and during the COVID-19 pandemic. 

The COVID-19 pandemic has acted as an independent risk factor for cerebrovascular disease, affecting stroke presentation and treatment workflows.

A retrospective observational study was conducted at Buffalo General Hospital, a comprehensive stroke center. Patients with acute stroke from March to May 2019 (pre-COVID-19 group, T1) and March to May 2020 (COVID-19 group, T2) were included. Clinical and demographic data were analyzed using Fisher’s Exact Tests, likelihood ratios, and independent samples t-tests.

A total of 810 patients were enrolled, with 441 in T1 and 369 in T2. Patients in T2 presented with significantly different symptoms, including increased weakness (p<0.01), loss of consciousness (p=0.021), balance issues (p<0.01), dizziness (p=0.046), and involuntary movements (p=0.03). Presentation times were also longer in T2 (p=0.042), and higher preadmission disability (p=0.001) was observed, measured by the modified Rankin Scale (mRS), though discharge mRS showed no significant difference between groups. Three-month outcome data was only available for patients receiving IV thrombolysis (IVT). In the subgroup of patients who received IVT, 93 were in T1 and 58 in T2, with those in T2 less likely to receive IVT (15.72% vs. 21.09%, p=0.051). Admission NIHSS scores were higher in T2, averaging 11.04 compared to 8.02 in T1 (p=0.038). No significant differences were found in admission mRS (p=0.479), discharge mRS (p=0.356), or 3-month mRS (p=0.578) for patients who received IV thrombolysis.

The COVID-19 pandemic significantly altered acute stroke presentations, with patients showing increased motor symptoms, loss of consciousness, balance issues, longer presentation times, and higher preadmission disability. Fewer patients qualified for IVT, but discharge and 3-month disability outcomes were unchanged in those who received it. However, 3-month outcomes couldn’t be assessed for the entire group, limiting the ability to determine the pandemic’s full impact.