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Mishra S, Choueka M, Wang Q, Hu C, Visone S, Silver M, Stein EG, Levine SR, Wang QT. Intracranial Hemorrhage in COVID-19 Patients. J Stroke Cerebrovasc Dis 2021; 30:105603. [PMID: 33484980 PMCID: PMC7831866 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105603] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To describe the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in COVID-19 patients. Methods Retrospective, observational, consecutive case series of patients admitted with ICH to Maimonides Medical Center from March 1 through July 31, 2020, who had confirmed or highly suspected COVID-19. Demographic, clinical, laboratory, imaging, and outcome data were analyzed. ICH rates among all strokes were compared to the same time period in 2019 in two-week time intervals. Correlation of systolic blood pressure variability (SBPV) and neutrophil-to-lymphocyte ratio (NLR) to clinical outcomes were performed. Results Of 324 patients who presented with stroke, 65 (20%) were diagnosed with non-traumatic ICH: 8 had confirmed and 3 had highly suspected COVID-19. Nine (82%) had at least one associated risk factor for ICH. Three ICHs occurred during inpatient anticoagulation. More than half (6) suffered either deep or cerebellar hemorrhages; only 2 were lobar hemorrhages. Two of 8 patients with severe pneumonia survived. During the NYC COVID-19 peak period in April, ICH comprised the highest percentage of all strokes (40%), and then steadily decreased week-after-week (p = 0.02). SBPV and NLR were moderately and weakly positively correlated to discharge modified Rankin Scale, respectively. Conclusions COVID-19 associated ICH is often associated with at least one known ICH risk factor and severe pneumonia. There was a suggestive relative surge in ICH among all stroke types during the first peak of the NYC pandemic. It is important to be vigilant of ICH as a possible and important manifestation of COVID-19.
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Affiliation(s)
- Sanskriti Mishra
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Murray Choueka
- Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Qiang Wang
- Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
| | - Chloe Hu
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States.
| | - Stephanie Visone
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States.
| | - Michael Silver
- Department of Research Administration, Maimonides Medical Center, Brooklyn, NY, United States.
| | - Evan G Stein
- Department of Radiology, Maimonides Medical Center, Brooklyn, NY, United States.
| | - Steven R Levine
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States; Department of Neurology, Kings County Hospital Center, Brooklyn, NY, United States.
| | - Qingliang T Wang
- Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Surgery/Division of Neurosurgery, Maimonides Medical Center, Brooklyn, NY, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
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