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Sars-Cov-2 and Stroke Characteristics: A Report From the Multinational Covid-19 Stroke Study Group Publisher Pubmed



Shahjouei S1 ; Tsivgoulis G2 ; Farahmand G3 ; Koza E7 ; Mowla A1 ; Vafaei Sadr A9 ; Kia A10 ; Vaghefi Far A4 ; Mondello S11 ; Cernigliaro A12 ; Ranta A13 ; Punter M13 ; Khodadadi F14 ; Naderi S5 Show All Authors
Authors
  1. Shahjouei S1
  2. Tsivgoulis G2
  3. Farahmand G3
  4. Koza E7
  5. Mowla A1
  6. Vafaei Sadr A9
  7. Kia A10
  8. Vaghefi Far A4
  9. Mondello S11
  10. Cernigliaro A12
  11. Ranta A13
  12. Punter M13
  13. Khodadadi F14
  14. Naderi S5
  15. Sabra M15
  16. Ramezani M16
  17. Amini Harandi A16
  18. Olulana O7
  19. Chaudhary D1
  20. Lyoubi A17
  21. Campbell BCV18
  22. Arenillas JF19
  23. Bock D20
  24. Montaner J21
  25. Aghayari Sheikh Neshin S22
  26. Aguiar De Sousa D23
  27. Tenser MS8
  28. Aires A23, 25, 26
  29. Alfonso MDL19
  30. Alizada O27
  31. Azevedo E25
  32. Goyal N28
  33. Babaeepour Z29
  34. Banihashemi G6
  35. Bonati LH30
  36. Cereda CW31
  37. Chang JJ32
  38. Crnjakovic M33
  39. De Marchis GM34
  40. Del Sette M35
  41. Ebrahimzadeh SA36
  42. Farhoudi M37
  43. Gandoglia I35
  44. Goncalves B38, 39
  45. Griessenauer CJ1
  46. Murat Hanci M27
  47. Katsanos AH2
  48. Krogias C40
  49. Leker RR41
  50. Lotman L42
  51. Mai J43
  52. Male S44
  53. Malhotra K45
  54. Malojcic B46
  55. Mesquita T47
  56. Mir Ghasemi A48
  57. Mohamed Aref H49
  58. Mohseni Afshar Z50
  59. Moon J51
  60. Niemela M52
  61. Rezai Jahromi B52
  62. Nolan L42
  63. Pandhi A28
  64. Park JH53
  65. Marto JP47
  66. Purroy F54
  67. Ranjiburachaloo S3
  68. Carreira NR24
  69. Requena M55, 56
  70. Rubiera M55, 56
  71. Sajedi SA57
  72. Sargentofreitas J58
  73. Sharma VK59
  74. Steiner T60, 61
  75. Tempro K42
  76. Turc G38
  77. Ahmadzadeh Y62
  78. Almasidooghaee M63, 64, 65
  79. Assarzadegan F1, 66
  80. Babazadeh A67
  81. Baharvahdat H68
  82. Cardoso FB69
  83. Dev A14
  84. Ghorbani M63
  85. Hamidi A70
  86. Hasheminejad ZS71
  87. Hojjatanasri Komachali S72
  88. Khorvash F73, 74
  89. Kobeissy F15
  90. Mirkarimi H75
  91. Mohammadivosough E75
  92. Misra D76
  93. Noorian AR77
  94. Nowrouzisohrabi P78
  95. Paybast S80
  96. Poorsaadat L81
  97. Roozbeh M82
  98. Sabayan B83
  99. Salehizadeh S84
  100. Saberi A22
  101. Sepehrnia M71
  102. Vahabizad F6
  103. Yasuda TA69
  104. Ghabaee M4
  105. Rahimian N85
  106. Harirchian MH3
  107. Borhanihaghighi A79
  108. Azarpazhooh MR86
  109. Arora R87
  110. Ansari S28, 89
  111. Avula V88, 89
  112. Li J88, 89
  113. Abedi V88
  114. Zand R1
Show Affiliations
Authors Affiliations
  1. 1. Neurology Department, Neuroscience Institute, Geisinger Health System, PA, United States
  2. 2. Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, attikon University Hospital, Greece
  3. 3. Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Iran
  4. 4. Neurology Department, Tehran University of Medical Sciences, Iran
  5. 5. Department of Neurosurgery, Tehran University of Medical Sciences, Iran
  6. 6. Imam Khomeini Hospital, Neurology Department, Sina Hospital, Tehran University of Medical Sciences, Iran
  7. 7. Geisinger Commonwealth School of Medicine, Scranton, PA, United States
  8. 8. Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA, United States
  9. 9. Department de Physique Theorique, Center for Astroparticle Physics, University Geneva, Switzerland
  10. 10. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York City, NY, United States
  11. 11. Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
  12. 12. Regional Health Authority of Sicily, Palermo, Italy
  13. 13. Department of Neurology, Wellington Hospital, Department of Medicine, University of Otago, New Zealand
  14. 14. Pes University, Karnataka, Bangaluru, India
  15. 15. Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon
  16. 16. Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  17. 17. Neurology Department, Delafontaine Hospital, Saint-Denis, France
  18. 18. Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
  19. 19. Department of Neurology, University of Valladolid, Spain
  20. 20. Department of Cardiology, Klinikum Frankfurt Hochst, Germany
  21. 21. Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
  22. 22. Neurology Department, Poursina Hospital, Rasht Guilan, Iran
  23. 23. Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal
  24. 24. Department of Internal Medicine, Hospital de Santa Maria, University of Lisbon, Portugal
  25. 25. Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
  26. 26. Department of Medicine, University of Porto, Portugal
  27. 27. Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey
  28. 28. Department of Neurology, University of Tennessee, United States
  29. 29. Neurology Ward, Valiasr Hospital, Borujen, Iran
  30. 30. Department of Neurology, Stroke Unit, University Hospital Basel, Switzerland
  31. 31. Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
  32. 32. Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, United States
  33. 33. Intensive Care Unit, Department of Neurology, Clinical Hospital Dubrava, Zagreb, Croatia
  34. 34. Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, University of Basel, Switzerland
  35. 35. Neurology Unit, Galliera Hospital, Genova, Italy
  36. 36. Department of Radiology, Yasrebi Hospital, Kashan, Iran
  37. 37. Neurosciences Research Center, Tabriz University of Medical Sciences, Iran
  38. 38. Department of Neurology, Ghu Paris Psychiatrie et Neurosciences, Universite de Paris, Inserm U1266, France
  39. 39. Division of Neurology, McMaster University, Population Health Research Institute, Hamilton, ON, Canada
  40. 40. Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
  41. 41. Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  42. 42. Department of Neurology, Albany Medical Center, NY, United States
  43. 43. Department of Neurosurgery, Georgetown University, MedStar Washington Hospital Center, DC, United States
  44. 44. Department of Neurosurgery, Vidant Medical Center, Greenville, NC, United States
  45. 45. Department of Neurology, Allegheny Health Network, Pittsburgh, PA, United States
  46. 46. Department of Neurology, Tia Clinic, University Hospital Centre Zagreb, Zagreb School of Medicine, University of Zagreb, Croatia
  47. 47. Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
  48. 48. Department of Anesthesiology, University of Ottawa, Canada
  49. 49. Department of Neurology, Ain Shams University, Cairo, Egypt
  50. 50. Infection Disease Research Center, Kermanshah University of Medical Sciences, Iran
  51. 51. Department of Neurology, National Medical Center, Seoul, South Korea
  52. 52. Department of Neurosurgery, Helsinki University, Helsinki University Hospital, Finland
  53. 53. Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, South Korea
  54. 54. Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomedica de Lleida, Universitat de Lleida, Spain
  55. 55. Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain
  56. 56. Department de Medicina, Universitat Autonoma de Barcelona, Spain
  57. 57. Department of Neurology, Neuroscience Research Center, Golestan University of Medical Sciences, Iran
  58. 58. Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
  59. 59. Division of Neurology, University Medicine Cluster, National University Health System, Singapore, Singapore
  60. 60. Department of Neurology, Klinikum Frankfurt Hochst, Germany
  61. 61. Department of Neurology, Heidelberg University Hospital, Germany
  62. 62. Hospital for Special Surgery, New York City, NY, United States
  63. 63. Divisions of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Iran
  64. 64. Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
  65. 65. Divisions of Vascular and Endovascular Neurosurgery, Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
  66. 66. Neurology, Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
  67. 67. Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Iran
  68. 68. Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Iran
  69. 69. Neurology Department, Centro Medico de Campinas, Sao Paulo, Brazil
  70. 70. Neurology Ward, Gheshm Hospital, Iran
  71. 71. Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran
  72. 72. Department of Neurology, Pirooz Hospital, Gilan University of Medical Sciences, Lahijan, Iran
  73. 73. Neurology Department, Isfahan University of Medical Sciences, Iran
  74. 74. Program of Neurotrauma, Neuroproteomics and Biomarker Research, University of Florida, United States
  75. 75. Neurology Department, Modarres Hospital, Kashmar, Iran
  76. 76. Steele Institute of Health and Innovation, Geisinger Health System, PA, United States
  77. 77. Department of Neurology, Southern California Permanente Medical Group, Irvine, CA, United States
  78. 78. Student Research Committee, Shiraz University of Medical Sciences, Iran
  79. 79. Clinical Neurology Research Center, Shiraz University of Medical Sciences, Iran
  80. 80. Department of Neurology, Bou Ali Hospital, Qazvin University of Medical Sciences, Iran
  81. 81. Department of Neurology, Arak University of Medical Sciences, Iran
  82. 82. Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  83. 83. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, United States
  84. 84. Neurology Department, Salahadin Ayubi Hospital, Baneh, Iran
  85. 85. Department of Neurology, Yasrebi Hospital, Kashan, Iran
  86. 86. Neurology Department, Western University, Canada
  87. 87. Department of Neurology, Long Island Jewish Forest Hills, Queens, NY, United States
  88. 88. Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, United States
  89. 89. Biocomplexity Institute, Virginia Tech, Blacksburg, VA, United States

Source: Stroke Published:2021


Abstract

Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2-infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries' health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3-17] versus 11 [5-17]; P=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P<0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures. © 2021 American Heart Association, Inc.
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