Acute cerebrovascular disorders and vasculopathies associated with significant mortality in SARS-CoV-2 patients admitted to the intensive care unit in the New York Epicenter

Objective: The current Coronavirus pandemic due to the novel SARS-Cov-2 virus has proven to have systemic and multi-organ involvement with high acuity neurological conditions including acute ischemic strokes. Background: Among neurological manifestations, multiple reports reflect emerging evidence for neurotropism of the novel SARS-CoV-2 virus, including frequent complaints of anosmia, seizures and less common reports of acute inflammatory demyelinating polyneuropathy, acute necrotizing encephalitis etc2. A hypercoagulable state has also been reported in many patients, characterized by thrombocytopenia, elevated fibrinogen and d-dimer levels leading to unusual cases of multifocal pulmonary thrombosis as well as acute ischemic strokes3-6. SARS-CoV-2 virus has also been implicated in autoimmune and auto-inflammatory disease leading to a vasculopathy and/or vasculitides1 among mounting reports of spontaneous coronary artery and cerebral artery dissection in COVID-19 patients without any history of antecedent trauma or connective tissue disorder(7-11). Design/Methods: We report a prospectively followed cohort of all hospitalized cases with confirmed COVID-19 infection (SARS-CoV-2 RT-PCR positive) and CVD (ischemic and hemorrhagic stroke) between March 26th and April 12th, 2020 treated at our comprehensive stroke center located in the New York City Metropolitan area. Diagnosis of CVD was confirmed on neuroimaging with CT, CTA and/or MRI of the brain. Baseline demographics, clinical, laboratory, diagnostic and imaging findings were extracted by a board-certified or board-eligible neurologist. Stroke etiology, according to the TOAST criteria for ischemic stroke, was determined based on available workup. Results: We admitted a total of 48 patients with acute ischemic stroke during the study period, 8 of whom had concomitant COVID-19 and were managed in the COVID Intensive care unit. Conclusions: In conclusion, based on the presumption that the infection with the COVID-19 virus results in a hyperinflammatory cascade, and consequently hypercoagulability, intensivists should have a high index of suspicion for cerebrovascular complications in the setting of this pandemic.