We reviewed medical charts at a tertiary hospital of patients with PCR-confirmed COVID-19, seen by neurology for delirium and underwent brain CT or MRI, from October 2020 to August 2021. Patients with acute stroke on the CT/MRI were compared with those with negative images. About fifty clinical or laboratory features were screened with univariate analysis and those with p<0.20 entered multivariate logistic regression. Discrimination was summarized by the area under the ROC curve.

Records of 97 COVID-19 patients with delirium were screened, 67 of them had brain imaging and entered the analysis. 23 (34.3%) patients were found to have an acute stroke on their images. Four significant independent predictors of acute stroke were found and these included focal neurological deficit (OR 10.09, 95% CI 1.16–87.48), respiratory symptoms (OR 8.18, 95% CI 1.16–57.52), ESR (OR 0.96, 95% CI 0.93–0.99), and D-dimer (OR 1.24, 95% CI 1.01–1.53). The overall discrimination was excellent with area under the curve (AUC) of 0.92.

In COVID-19 patients with delirium, focal neurologic deficit and respiratory symptoms, and to a lesser extent, lower ESR and higher D-dimer levels are significant predictors of acute stroke. Doing brain imaging (CT/MRI) for patients with such risk factors is warranted.