High rates of unexplained strokes and delayed recognition of
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In a case series study that explored the association of COVID-19 and acute ischemic stroke, researchers at Emory University Hospital observed higher than expected rates of unexplained or "cryptogenic" strokes, as well as delays in stroke presentations or symptom recognition. Results were published in PLOS ONE.

The study looked at COVID-19 patients with ischemic stroke from the Emory University Hospital system. Of 396 ischemic stroke patients admitted during the study, 13 were diagnosed with COVID-19. Researchers found the occurrence of stroke greater in COVID-19 patients who had risk factors like diabetes, hypertension, hyperlipidemia or atrial fibrillation/flutter. Males and African Americans were predominantly affected by strokes in the study.

Interestingly, while cryptogenic strokes account for only 10 to 30% of all strokes, in this study, researchers found it in 69% of the patient population which is extremely high and suggests the possibility of COVID-19 as a likely contributory factor in this presentation.

Researchers said compared with the patients who did not have COVID-19, this was a statistically significant difference of 69% of strokes of cryptogenic etiology in the COVID-19 ischemic stroke group compared to only 17% in the non-COVID ischemic stroke group.

One of the most important findings from our study also pertains to the delayed recognition of stroke symptoms either due to delays in presentation or recognition of symptoms.

The study observed a prolonged average amount of time to presentation and symptom recognition averaging up to five days, a potential impact of the COVID crisis. These delays limited the use of acute reperfusion treatments, including drugs and surgery, to restore blood flow in or around the blocked vessels which can only be used when patients present within a 24-hour period.

The researchers explained that delayed presentations could be a result of patients waiting longer before coming to the hospital due to self-isolation or quarantine precautions or the fear of contracting COVID that have led to a general decline in acute stroke evaluations across the country.

Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239443