Ericka Samantha Teleg, MD

Bekelis K, Missios S, Ahmad J, Labropoulos N, Schirmer CM, Calnan DR, Skinner J, MacKenzie TA. Ischemic Stroke Occurs Less Frequently in Patients With COVID-19: A Multicenter Cross-Sectional Study. Stroke. 2020;51:3570–3576.

COVID-19 has affected stroke systems all over the globe, including diagnosis, recognition, and even management in stroke centers and hospitals. Stroke times may have been compromised due to the evolving COVID-19 crisis. The strength of COVID-19 and stroke studies in general allows the stroke neurologist and other practitioners to navigate during the COVID-19 crises.

Bekelis et al. emphasize that despite the presence of multiple case series and observational studies regarding the stroke milieu in the time of COVID-19, there exists a decreased occurrence of ischemic stroke across the world during the COVID-19 pandemic. This statement emphasizes that despite the circumstances we face at this complicated time, we must urge patients not to delay stroke care, despite the risk of COVID-19 contraction. The title that includes “less frequently” has made this reader quite interested to understand what the authors mean.

This article aims to study the association of COVID-19 with the occurrence of ischemic stroke. The strength of this article emphasizes the analysis on the frequency of unfavorable outcomes in ischemic stroke patients with COVID-19. There are currently limited reports on the impact of COVID-19 on stroke outcomes. The cross-sectional methodology allows one to be able to analyze certain variables, namely the outcome variables; the primary outcome variable includes the occurrence of new onset stroke in the cross-section of patients that can be analyzed to be able to determine the association of ischemic stroke and COVID-19 infection using hospital discharges from six hospitals. Exposure variables identified include race, age, gender, insurance status, and thrombolysis treatment with mechanical thrombectomy. Risk adjustment of variables is important in the analysis of variables. This study has robust data based on 24,808 discharged patients.

The results are important in that they demonstrated that stroke patients with COVID-19 infection demonstrated increased case-fatality rate and a trend of more discharge to rehabilitation. The analysis of risk factors with COVID-19 and its association with stroke risk is the strength of this article. The authors observed mortality for COVID-19 positive patients with stroke to be 31.8% as compared to 4.6% for COVID-19 negative patients with stroke — knowledge that can be valuable to the stroke community as we navigate through this COVID-19 pandemic. Namely, the authors did not identify an increased frequency of myocardial infarction among COVID-19 patients. They noted that although several recent studies have highlighted findings of a younger cohort of patients with COVID-19 and stroke, their study did not.

We are navigating through uncertain times. Bekelis et al. sheds light on our uncertain navigation towards effective stroke diagnosis during the time of COVID-19.