COVID-19 and Stroke Risk: A Double Whammy

Abstract

The emphasis so far during the COVID-19 pandemic has been on the respiratory manifestations with little attention being given to neurological manifestations. Literature has shown multiple cases of stroke being associated with COVID-19. Thus, there is great interest in the role of the virus in stroke pathogenesis. Regarding hyperacute and acute stroke treatment, the routine guidelines for thrombolysis and thrombectomy are to be followed with emphasis on high suspicion of COVID-19 in stroke cases with respiratory symptoms or with contact/travel history. Secondary risk factor treatment for hypertension, diabetes, dyslipidemia is a must. We recommend continuing angiotensin converting enzyme 2 inhibitors/angiotensin II receptor blockers (ARBs) in those who are taking these medications as per evidence available. Mandatory lockdown has led to delay in presentation to the hospital with a decrease in thrombolysis due to ineligibility and a corresponding increase in primary thrombectomies being performed. Telemedicine could be an important tool to triage cases worthy of tertiary referral from other strokes and must be encouraged.

Keywords

• covid-19
• stroke
• sars-cov-2
• risk factors
• pandemic