. 2020 Nov 17;2(2):76–83. doi: 10.1016/j.hest.2020.11.001

Table 1.

Summary of literature with a focus on stroke in COVID-19 patients.

Authors	Journal	Publication Date	Study type	Number of Stroke Patients	Age (Median)	Sex	Characteristics	Outcome
Yaghi et al. ¹	Stroke	Jul-20	Cohort study	32	62.5[52.0–69.25]	23 Male	0.9% (32/3556) hospitalized COVID-19 infection identified with stroke	75.0% (24/32) deceased/critically ill
						9 Female	Median time from COVID-19 Symptoms to stoke 10 days [5–16.5]
							43.8% (14) admitted for stroke; 56.2% (18) admitted for COVID-19 related symptoms
							21.9% (7) cardioembolic; 6.3% (2) Large Vessel disease
							65.6% (21) cryptogenic, 6.3% (2) other types of stroke
							Median D-dimer 3913 ng/mL (2549–10000); median CRP 101.1 ng/mL (38.8–214.3)
Morassi et al. ⁵⁶	Journal of Neurology	Apr-20	Case series	6	69[57–82]	5 Male	Four ischemic strokes; two hemorrhagic strokes Five males with severe COVID-19; one female with moderate COVID-19; Increased LDH, abnormal blood clotting tests in four patients	Death (83%) 5 (severe COVID-19 all died); severe neurological deficits (mRS:4)
						1 female
Klok et al. ¹⁸	Thrombosis Research	Apr-20	Cohort study	3	n/a^a	n/a	Focused on thrombotic complications in critically ill COVID-19 patients. Reported 3 ischemic strokes.	n/a
Mao et al. ⁵	JAMA Neurology	20-Apr	Cohort study	6	n/a	n/a	Study focused on neurological manifestations of COVID-19 patients; five ischemic stroke, one hemorrhagic stroke was reported; Five severe covid-19 cases, one non-severe COVID-19 case; Median time from COVID-19 symptoms to stroke 9 days (1 to 18)	One hemorrhagic stroke died; others unknown
Helms et al. ²⁰	The New England Journal of Medicine	Jun-20	Case series	3	n/a	n/a	Observation case series with a focus on neurological features. Reported three patients with ischemic stroke.	n/a
Helms et al. ³³	Intensive care Med	Apr-20	Cohort study	4	n/a	n/a	Focused on high thrombosis risks in COVID-19 patients, reported four stroke patients, no details regarding age and outcome etc.	n/a
Li et al.⁴	SSRN Electronic Journal	Jul-20	Retrospective observational study	13	72 [32–91]	7 Male	Eleven acute ischemic strokes, 1 CVST^b, 1 cerebral hemorrhage	38.5% (5) death
						6 Female	11 severe COVID-19; 2 non-severe COVID-19
							Median time from COVID symptoms to stroke 9 days (0 to 28)

Authors	Journal	Publication date	Study type	Number of Stroke Patient	Age (median)	Sex	Characteristics	Outcome
Merkler et al.⁵⁷	JAMA Neurology	20-Jul	Retrospective observational study	31	69 (interquartile range, 66–78)	18 Male 13 Female	All presented with ischemic stroke; 8 patients presented with stroke initially.	n/a
Avula et al.¹¹	Brain, Behavior, and Immunity	Apr-20	case report	4	81.5 [73–88]	1 Male 3 Female	All patients presented with acute ischemic stroke with COVID-19; Of patients who had D-dimer and CRP^c tested, they are all increased; D-dimer CRP levels both elevated when data available	3 died; 1 discharged to rehab
Valderrama et al.⁵³	Stroke	Jul-20	Case report	1	52	Male	Patient presented with covid-19 symptoms, developed stroke on day 7 of COVID-19 symptoms; Angiography revealed partially occlusive left terminal internal carotid artery thrombus; Mechanical thrombectomy was performed; D-dimer and CRP were both high.	Discharged
Guillan et al.⁵⁸	Thrombosis Research	Sep-20	Case report	1	67	Male	Simultaneous presentation of ischemic stroke and mild Covid-19; Cerebral infracts in multiple arterial territories; High D-dimer and CRP.	Favorable without new clinical events
Vu et al.⁵⁹	Emergency Radiology	Mar-20	Case report	1	30	Male	Presented with dysarthria, right hemiparesis, right facial droop; CT showed acute left basal ganglia hemorrhage (hemorrhagic stroke); Asymptomatic COVID-19 (CT neck revealed nodules in both upper lobes of the lung, which led to covid-19 diagnosis eventually)	n/a
Fu et al.⁶⁰	BMC Neurology	Jun-20	Case report	2	45	Male	Six days after mild covid-19 symptom (fever), patient developed stroke symptoms including dysarthria, weakness of left limbs, facial droop. CT revealed right corona radiata infarction; D-dimer and CRP were both high.	Recovered, discharged
					50	Male	Patient presented with left side weakness after 9 days of fever; Confirmed with COVID-19 with rt-PCR^d; CT showed right basal ganglia infarction; D-dimer and CRP both high.	Discharged with residual neurological deficits
Gunasekeran et al.⁶¹	QJM	May-20	Case report	1	40	Female	Seven days after intubation, patient showed sluggish pupils and absent corneal responses. CT revealed a large middle cerebral artery territory infarct with extensive mass effect, including midline shift and downward herniation. Patient had diabetes insipidus which was deemed the cause of the massive stroke.	Deceased


Authors	Journal	Publication date	Study type	Number of Stroke Patient	Age (median)	Sex	Characteristics	Outcome

Oxley et al.⁶²	The New England Journal of Medicine	Apr-20	Case Report	5	39 [33–49]	4 Male 1 Female	Moderate to mild COVID-19 infection; all had large vessel disease; mean NIHSS upon admission was 19;	3 discharged home or rehab, 1 in ICU, 1 in stroke unit
Beyrouti et al.⁶³	J neurol Neurosurg Psychiatry	May-20	Case report	6	68.5 [53–85]	5 Male 1 Female	Five severe and one moderate COVID-19 infection; CT or MRI confirmed ischemic stroke; CRP all elevated; antiphospholipid antibodies were all detected.	1 died; others unknown
Sharifi-Razavi et al.⁶⁴	New Microbes and New Infections	Mar-20	Case report	1	79	Male	Three days after COVID-19 symptoms (fever, cough), patient presented with loss of consciousness, hemorrhagic stroke confirmed with CT, rt-PCR confirmed Covid-19.	unknown
TUNÇ et al.⁶⁵	Journal of clinical Neuroscience	20-May	case report	4	69.5 [45–77]	2 Male 2 Female	Median 1.5 days (1–4) stroke presentation after COVID-19 symptoms; COVID-19 non-severe; two patients had large vessel disease; two patients had small vessel disease.	2 discharged well; 2 bedridden, all survived.
Goldberg et al.⁶⁶	AJNR Am J Neuroradiol	May-20	case report	1	64	Male	Sixteen days after onset of COVID-19 symptoms, patient woke up with hemiparesis. CT confirmed right middle cerebral artery and bilateral anterior cerebral artery territories acute ischemic infarction; high D-dimer and antiphospholipid antibodies.	n/a
Hughes et al.¹²	European Journal of Case Report in Internal Medicine	20-Apr	case report		59	Male	Presented with right hemiparesis, dysphasia 4 days after COVID-19 confirmation, was diagnosed with cerebral venous sinus thrombosis.	Recovered
Carroll et al.⁶⁷	Neurocrit care	Jun-20	Case report	2	66 [62–72]	Male	Two severe COVID-19 cases under intubation were absent of brainstem reflexes; CT revealed multifocal hemorrhages and severe diffuse cerebral edema.	Deceased
Fara et al.⁶⁸	Journal of Thrombosis and Haemostasis	May-20	Case report	3	33	Female	Patient with no medical history presented with left hemiplegia and left facial hypoesthesia; MRI revealed acute infarction in the right middle cerebral artery territory. Treated with anticoagulation.	Near-complete resolution of thrombosis.
					77	Female	Patient with history of hypertension and hyperlipidemia presented with sudden onset of aphasia, left hemiparesis. Found to have non-occlusive thrombosis of the distal right common carotid artery. (coughing led to confirmation with COVID-19, no fever, no oxygenation supplementation required).	Thrombosis had completely resolved
					55	Male	Patient with history of diabetes presented with left hemiparesis. CTA showed thrombosis of right common carotid artery. Conventional angiography showed the thrombosis as non-occlusive, and he was treated with anticoagulation. Low-grade fever at presentation and required supplemental oxygenation, but did not develop significant respiratory distress.	n/a
Zahid et al.¹⁷	Journal of Stroke	Jun-20	Case report	1	38	Male	Patient had severe Covid-19, was intubated and later on put on ECMO^e support with continuous heparin infusion. Patient developed encephalopathic and head CT revealed left sub-insular parenchymal hemorrhage.	Obtained overall substantial clinical improvement.

n/a: not available (data not provided in the original publications);

CVST: Cerebral venous sinus thrombosis;

CRP: C-reactive protein;

rt-PCR: reverse transcription polymerase chain reaction;

ECMO: extracorporeal membrane oxygenation.