Does COVID-19 Increase the Risk of Stroke?

For Dr. Cucchiara’s study, which was published in Stroke in July, he and his coauthors analyzed data from patients with COVID-19 admitted to the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, and Pennsylvania Hospital between March and May. They found that of the nearly 850 patients, 28 had suffered strokes.

A small case study published in The New England Journal of Medicine on April 28 identified large-vessel stroke as a presenting feature of COVID-19 in patients under 50-years-old. Accounts of other instances were cropping up on different news outlets.

“We really didn’t know whether this was going to turn out to be a big issue or not,” says Dr. Cucchiara. “At the time, it looked like we were on the cusp of an epidemic of stroke in young people with COVID.”

Instead, they found that not only was stroke a relatively rare occurrence among their COVID-19 patients, but most of those cases could be traced back to traditional stroke risk factors.

“The majority of them were older patients who had a lot of pre-existing risk factors, like high blood pressure and diabetes,” says Dr. Cucchiara.

That’s not to say, though, that the issue shouldn’t be explored.

“There clearly is some issue with the inflammatory response the body generates when there’s coronavirus infection that leads to more clotting. Forgetting about the specific infection, the mechanisms underlying that are really interesting. And I think they’re telling us something more, generally, about how people form blood clots and how that leads to heart attacks, strokes, and other clotting conditions,” Dr. Cucchiara says.

What can COVID-19 teach us?

For Joseph R. Berger, MD, FACP, FAAN, FANA, Professor of Neurology at Penn Medicine and Associate Chief of the MS Division, the goal now is to focus the ambition that spurred these studies and others that are currently in progress. Recently, he proposed that Penn establish a formal program within the Department of Neurology to study the neurologic complications associated with COVID-19.

“Penn Medicine is uniquely positioned in that it has a broad spectrum of experience and an incredible depth of expertise,” says Dr. Berger, a central figure in the study of the neurologic complications of HIV at the height of the HIV/AIDS global epidemic. “And there seems to be a more than adequate number of individuals who have an interest in understanding these complications. We have the capacity to make the kind of headway with COVID-19 that took a number of academic centers to accomplish with HIV.”