Objective: To describe the ischemic stroke etiopathogenesis related to COVID-19 in a cohort of NYC hospitals. Background: Extra-pulmonary involvement of COVID-19 has been reported in the hepatic, renal and hematological systems. Most neurological manifestations are non-focal but few have reported the characteristics of ischemic strokes or investigated its pathophysiology. Methods: Over the last 6 weeks, data from four centers in New York City were collected to review the possible ischemic stroke types seen in COVID-19 positive patients. Their presentation, demographics, other related vascular risk factors, associated laboratory and coagulation markers, as well as imaging and outcomes were collected. Results: In our study, age range of patients was 25-75 with no significant male preponderance. 70% presented for acute hospitalization due the stroke. About a fifth did not have common risk factors for ischemic stroke like diabetes and hypertension. None had history of atrial fibrillation or smoking. 50% had poor outcome with four ending in mortality and one in a critical condition due ARDS. All had high Neutrophil/Lymphocyte ratio except one who demonstrated some neurological recovery. In 70% of our cases, D-dimer levels were collected, and all showed mild to severe elevation. None of the emergent large vessel occlusion (LVO) cases had known cardiac risk factors but two out of five were found to have cardiac abnormalities during the course of their hospitalization. All LVOs had hypercoagulable lab markers especially elevated D-dimer and/or Fibrinogen. The LVO patients were younger and sicker with a median age of 46 and mean NIHSS of 24 as opposed to non-LVOs with a median age of 62 and mean NIHSS of 6 respectively. Conclusion: COVID-19 related ischemic events can be small vessel, branch emboli or large vessel occlusions. The latter is often associated with either a hypercoagulable state or cardio-embolism. Patient outcomes were worse when multi-organ or pulmonary system failure prevailed. Keywords: COVID-19, Acute Ischemic strokes, Emergent Large Vessel Occlusion, Mechanical Thrombectomy

中文翻译：

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SARS-COV-2病毒患者缺血性卒中的病因亚型

目的：描述纽约市队列中与COVID-19相关的缺血性中风的病因。背景：在肝，肾和血液系统中已报告了COVID-19的肺外受累。大多数神经系统表现是非局灶性的，但很少报道缺血性中风的特征或研究其病理生理学。方法：在过去的6周中，收集了来自纽约市四个中心的数据，以审查在COVID-19阳性患者中可能出现的缺血性中风类型。收集他们的表现，人口统计学，其他相关的血管危险因素，相关的实验室和凝血指标以及影像学和预后。结果：在我们的研究中，患者年龄范围为25-75岁，无明显男性优势。70％因中风而急诊住院。大约五分之一的人没有患缺血性中风的常见危险因素，例如糖尿病和高血压。没有人有房颤或吸烟史。50％的患者预后较差，其中4例死亡，1例由于ARDS处于危急状态。除一名神经功能恢复正常者外，其余所有患者均具有较高的中性粒细胞/淋巴细胞比。在我们的70％的病例中，收集了D-二聚体水平，所有水平均显示轻度至重度升高。没有新出现的大血管闭塞（LVO）病例具有已知的心脏危险因素，但五分之二的人在住院期间发现了心脏异常。所有LVO都有高凝实验室标记物，尤其是D-二聚体和/或纤维蛋白原升高。LVO患者年龄较小，病情较轻，中位年龄为46岁，平均NIHSS为24，而非LVO患者的平均年龄为62岁，平均NIHSS为6。结论：COVID-19相关的缺血事件可以是小血管，分支栓塞或大血管闭塞。后者通常与高凝状态或心脏栓塞有关。当多器官或肺系统衰竭盛行时，患者的预后较差。关键字：COVID-19，急性缺血性中风，紧急大血管闭塞，机械血栓切除术