COVID-19 risk of severe stroke

Doctors across the world are finding that incidences of strokes in patients suffering from COVID-19 are associated with worse outcomes including a higher mortality rate.

A research study comparing patients with COVID-19 and acute ischemic stroke to patients suffering from stroke alone was published in the journal Stroke.

The researchers analyzed clinical data and outcomes of 174 patients with COVID-19 and acute ischemic stroke. These patients were matched and their clinical outcomes compared with non-COVID-19 patients with acute ischemic stroke. These patients were matched on several factors including age, gender, and stroke risk factors. The stroke risk factors included were hypertension, diabetes, heart disease, coronary artery disease, cancer, previous stroke, smoking, obesity, and dyslipidemia (high levels of triglycerides or cholesterol in blood). A total of 330 patients were included in this study. The study included patients with COVID-19 and stroke being treated at 28 health care centers in 16 countries. The data for comparison with patients without COVID-19 was taken from the ASTRAL (Acute Stroke Registry and Analysis of Lausanne) Registry for the period from 2003 to 2019.

Clinical outcomes related to stroke severity and stroke outcome were estimated according to the National Institute of Health Stroke Scale. Comparison of the two patient groups, with and without COVID-19 showed that:

Patients with COVID-19 suffered more severe strokes with a median score of 10 on the NIHSS versus 6 amongst the non-COVID-19 patients;

Patients with COVID-19 suffered from more severe disability after stroke with a median Rankin score of 4 as compared to non-COVID-19 patients with a median Rankin score of 2 (Rankin score is a measure of disability resulting from a stroke);

Odds of a patient with COVID-19 and stroke dying is 4.3 times higher than patients with stroke alone.

Possible reasons for the increased risk of mortality and disability amongst COVID-19 patients

The researchers hypothesize that the body’s response to COVID-19 infections such as the immune response, dehydration, and cardiac arrhythmias can also result in conditions that promote the formation of blood clots within the blood vessels. This in turn increases the risk of stroke. Additionally, the researchers also note that the increased stroke severity of the patients with COVID-19 at the time of admission as compared to the non-COVID-19 group might contribute to the worse outcomes observed. They note in the study, “The broad multi-system complications of COVID-19 including acute respiratory distress syndrome, cardiac arrhythmias, acute cardiac injury, shock, pulmonary embolism, cytokine release syndrome and secondary infection probably contribute further to the worse outcomes including higher mortality in these patients.”

This study highlights the need for a better understanding of the underlying mechanisms behind the association of COVID-19 and the severity of stroke, especially in terms of awareness and treatment options during this and any future pandemics.

Written by Bhavana Achary, Ph.D.


Ntaios G, Michel P, Georgiopoulos G, et al. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke. 2020;10.1161/STROKEAHA.120.031208

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Image by Gerd Altmann from Pixabay 

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