Abstract Objective Acute stroke remains a medical emergency even during the COVID-19 pandemic. Most patients with COVID-19 present with constitutional and respiratory symptoms, some patients present with atypical symptoms including gastrointestinal, cardiovascular, or neurological symptoms. Here we present a series of four COVID-19 patients with acute stroke as a presenting symptom. Methods We searched the hospital databases for patients presenting with acute strokes and suspected COVID-19 features. All patients that had imaging confirmed strokes and PCR confirmed COVID-19 were included in the study. Patients admitted to the hospital with PCR confirmed COVID-19 disease whose hospital course was complicated with acute stroke while inpatient were excluded from the study. Retrospective patient data were obtained from electronic medical records. Informed consent was obtained. Results We identified four patients presenting with imaging confirmed acute strokes and PCR confirmed SARS-CoV-2 infection. We elucidate the clinical characteristics, imaging findings, and the clinical course. Conclusions Timely assessment and hyperacute treatment is the key to minimize mortality and morbidity of patients with acute stroke. Stroke teams should be wary of the fact that COVID-19 patients can present with cerebrovascular accidents and dawn appropriate personal protective equipment in every suspected patient. Further studies are urgently needed for a comprehensive understanding of the neurological pathology of COVID-19 and its effects on the nervous system.

中文翻译：

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COVID-19 表现为中风

摘要 目的 即使在 COVID-19 大流行期间，急性中风仍然是一种医疗紧急情况。大多数COVID-19患者出现全身和呼吸道症状，部分患者出现非典型症状，包括胃肠道、心血管或神经系统症状。在这里，我们介绍了四名以急性中风为主要症状的 COVID-19 患者。方法 我们在医院数据库中搜索了出现急性中风和疑似 COVID-19 特征的患者。所有经影像学检查确诊为中风且通过 PCR 确诊为 COVID-19 的患者均纳入该研究。入院经 PCR 确诊为 COVID-19 疾病且住院病程并发急性卒中的患者被排除在研究之外。从电子病历中获得回顾性患者数据。已获得知情同意。结果 我们确定了 4 名患者，其影像学证实为急性中风，PCR 证实为 SARS-CoV-2 感染。我们阐明临床特征、影像学表现和临床病程。结论及时评估和超急性治疗是降低急性脑卒中患者死亡率和发病率的关键。中风团队应警惕 COVID-19 患者可能出现脑血管意外的事实，并为每位疑似患者配备适当的个人防护装备。迫切需要进一步研究以全面了解 COVID-19 的神经病理学及其对神经系统的影响。