SARS-CoV-2-Associated Cerebrovascular Disease Amid the COVID-19 Pandemic: A Systematic Review

Figures & data

Table 1 Clinical Characteristics of the 119 COVID-19 Patients with Acute Ischemic Stroke

Ischemic Stroke Patients (n=119)
Characteristic	Value (n=44)
Median age (years, range)	62–64
Male sex, n(%)	51(42.9)
Female sex, n(%)	30(25.2)
Duration, median (range, days)
Time interval from COVID-19 to stroke (days)	9.0(0–33)
General symptoms before the onset of the AIS, n(%)	85(71.4)
Cough	65(54.4)
Fever	60(50.4)
Hypoxia	30(25.2)
Dyspnea	20(16.8)
Myalgia and fatigue	9(7.6)
Headache	3(2.5)
Gastrointestinal manifestations	7(5.9)
Risk factor, n(%)	85(71.4)
Hypertension	59(49.6)
Diabetes	32(26.9)
Hyperlipidemia	28(23.5)
Coronary artery disease	12(10.1)
Atrial fibrillation	13(10.9)
Prior stroke	6(5.0)
Previous valvular diseases	2(1.7)
Previous cancers	4(3.4)
Signs and symptoms of stroke, n(%)	61(51.3)
Hemiplegia/hemiparesis	19(16.0)
Reduced consciousness	19(16.0)
Weakness of limbs	14(14.3)
Dysarthria	12(10.1)
Facial droop	10(8.4)
Aphasia	7(5.9)
Ataxia	7(5.9)
Dysphasia	3(2.5)
Stroke mechanism, n(%)
Large artery atherosclerosis	59(47.1)
Small vessel disease	9(7.5)
Cryptogenic	21(17.6)
Cardioembolic stroke	21(17.6)
Laboratory values, n(%)
Increased D-dimer	80(67.2)
Normal D-dimer	12(10.0)
Increased CRP	50(42.0)
Normal CRP	33(27.7)
Treatment, n(%)
Anticoagulation	46(38.7)
Intravenous thrombolysis	15(12.6)
Mechanical thrombectomy	18(15.1)
Clot retrieval	11(9.2)
Aspirin	18(15.1)
Clopidogrel	11(9.2)
Aspirin and clopidogrel	9(7.6)
Outcomes, n(%)
Fatal outcome	32(26.9)
Poor (ie, bedridden, hospitalized, critically ill, ICU stay)	21(17.6)

Table 2 Clinical Characteristics of the 33 COVID-19 Patients with Cerebral Hemorrhage

Cerebral Hemorrhage Patients (n=33)
Characteristic	Value (N =33)
Median age (range, years)	58(19–81)
Male sex, n(%)	24(72.7)
Female sex, n(%)	9(27.3)
General symptoms before the onset of cerebral hemorrhage, n(%)
Cough	15(45.5)
Fever	15(45.5)
Shortness of breath/Dyspnea	13(39.4)
Gastrointestinal manifestations	7(5.9)
Risk factor, n(%)
Hypertension	10(30.3)
Diabetes	6(18.2)
Hyperlipidemia	2(6.1)
None	7(21.2)
Atrial fibrillation	1(3.0)
Aortic valve replacement	1(3.0)
Previous cancers	2(6.1)
Signs and symptoms of stroke, n(%)	29(87.9)
Reduced consciousness	8(24.2)
Altered pupils	9(27.2)
GCS, n(%)	7(21.2)
GCS, mean (range)	8.7(3–13)
Location of cerebral hemorrhage, n(%)
Frontal lobe	11(33.3)
Parietal lobe	5(15.2)
Temporal lobe	5(15.2))
Brain stem	4(12.1)
Basal ganglia	4(12.1)
Cerebellar hemisphere	2(6.1)
Laboratory values, n(%)
Increased D-dimer	16(48.5)
Increased CRP	8(24.0)
Normal CRP	4(12.1)
Treatment, n %)
Anticoagulation	7(21.2)
Outcomes, n(%)
Dead	16(48.5)
Poor	4(12.1)
Discharged	7(21.2)

Table 3 Clinical Characteristics of the 119 COVID-19 Patients with Cerebral Venous Thrombosis

Cerebral Venous Thrombosis Patients (n=12)
Characteristic	Value (N= 44)
Median age (range, years)	52.6(23–81)
Male sex, n(%)	8(66.7)
Female sex, n(%)	4(33.3)
Duration, median (range, days)
Time interval from COVID-19 to stroke (days)	11.4 (2–24)
General symptoms before the onset of the AIS, n(%)
Cough	5 (41.7)
Fever	8(66.7)
Myalgia and fatigue	9(7.6)
Headache	1(8.3)
Gastrointestinal manifestations	1(8.3)
Risk factor, n(%)	7(58.0)
Hypertension	3(25.0)
Diabetes	2(16.7)
Hyperlipidemia	28(23.5)
On oral contraceptive pills	1(8.3)
Previous stroke	1(8.3)
Previous cancers	2(16.7)
Signs and symptoms of stroke, n(%)
Reduced consciousness	7(58.3)
Headache	4(33.3)
Laboratory values, n(%)
Increased D-dimer	8(66.7)
Normal D-dimer	1(8.3)
Increased CRP	4(33.3)
Normal CRP	1(8.3)
Increased normal fibrinogen	1(8.3)
Normal fibrinogen	4(33.3)
Location of thrombosis, —n(%)
Transverse sinus	6(50.0)
Sigmoid sinus	4(33.3)
Straight sinus	5(41.7))
Vein of Galen	4(33.3)
Internal cerebral veins	4(33.3)
Sagittal sinus	4(33.3)
Torcular herophili	3(25.0)
Deep medullary veins	1(8.3)
Straight vein	1(8.3)
Internal jugular vein	1(8.3)
Deep medullary veins	1(8.3)
Treatment, n(%)
Anticoagulation	6(50.0)
Mechanical thrombec3tomy	2(16.7)
Outcomes, n(%)
Fatal outcome	5(38.5)
Discharged	2(16.7)