Young adult patients recovering from COVID-19 might be at increased risk of acute ischemic stroke

1. The rate of acute ischemic stroke was elevated in South Asian males recovering from asymptomatic SARS-CoV-2 2019 (COVID-19) infection.

Evidence Rating Level: 4 (Below Average)

Study Rundown: There is growing evidence to suggest that acute SARS-CoV-2 (COVID-19) infections may increase the risk of acute ischemic stroke (AIS). However, AIS in asymptomatic COVID-19-infected individuals recovering from the virus has yet to be investigated. This case series explored the incidence of AIS during the post-COVID-19 infection phase in asymptomatic adults 50 years or younger. 18 patients were diagnosed with AIS among the 54 485 individuals who tested positive for COVID-19 by serological testing during the study period. The calculated annual incidence rate of AIS was significantly higher in this cohort compared to the rate of an age-, sex-, and ethnicity-matched group from national data. None of the patients demonstrated evidence of respiratory disease through clinical and radiological assessment, and all survived during AIS hospitalization. These findings imply an increased risk of AIS cases in asymptomatic males post-COVID-19-infection. One limitation of this case series study, however, was that it examined only males in only one region with a very limited sample size. A larger, multi-centre prospective cohort study would be appropriate to better assess the risk of AIS in asymptomatic individuals post-COVID-19-infection.

Click to read the study in JAMA Network Open

Relevant Reading: Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza

In-Depth [case series]: This case series prospectively included South Asian adult males (50 years or younger) who worked in Singapore and lived in dormitories from May 21, 2020 to October 14, 2020 (21 weeks). The 54 485 people who tested positive for SARS-CoV-2 serological (antibodies) tests were considered the population at risk. The primary outcome was the incidence of AIS cases compared to an age-, sex-, and ethnicity-matched cohort. 18 patients (median [range], 41 [35-50] years) presented with AIC, and the median (range) time from positive serological test to AIS presentation was 54.5 (0-130) days. Large vessel occlusion was found on imaging in 10/18 patients (56%). Annual Incidence rates of AIS were significantly higher in this cohort (82.36 cases per 100 000 people) compared to the incidence rate of an age-, sex-, and ethnicity-matched group from national data (38.2 cases per 100 000 people) (rate ratio, 2.16; 95% CI: 1.36-3.48; p< 0.001).

Image: PD

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