ArticleBrain circulation
Bihemispheric ischemic strokes in patients with COVID-19.
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Who cites it
10 citing papers in PubMed, 15 citations in OpenAlex.
- Development and internal validation of a multidimensional nomogram integrating PIV, LDH, and FeNO for predicting poor asthma control in school-aged children.Frontiers in pediatrics · 2026Article
- Lactate dehydrogenase and short-term mortality in ICU patients with ischemic stroke: a single-center retrospective analysis of MIMIC-IV.European journal of medical research · 2025Article
- Expression of SARS-CoV-2 entry receptor ACE2 in human brain and its association with Alzheimer's disease and COVID-19.Molecular psychiatry · 2025Review
- Trends in Ischemic Stroke Hospitalization and Outcomes in the United States Pre- and Peri-COVID-19 Pandemic: A National Inpatient Sample Study.Journal of clinical medicine · 2025Article
- APOEε4 Carriers Exhibit Objective Cognitive Deficits: A Cross-Sectional Study in a Single Center Trial.Brain sciences · 2024Article
- Epidemiology, pathogenesis, and management of Coronavirus disease 2019-associated stroke.Frontiers of medicine · 2023Review
- Identification of brain endothelial cell-specific genes and pathways in ischemic stroke by integrated bioinformatical analysis.Brain circulationArticle
- A stroke in severe acute respiratory syndrome coronavirus 2 infected is not necessarily a COVID-stroke.Brain circulationArticle
- Restlessness with manic episodes induced by right-sided multiple strokes after COVID-19 infection: A case report.Brain circulationArticle
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Authors and funding
16 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is emerging evidence that COVID-19 can trigger thrombosis because of a hypercoagulable state, including large-vessel occlusion ischemic strokes. Bihemispheric ischemic stroke is uncommon and is thought to indicate an embolic source. Here, we examine the findings and outcomes of patients with bihemispheric stroke in the setting of COVID-19.
methodsWe performed a retrospective cohort study at a quaternary academic medical center between March 1, 2020, and April 30, 2020. We identified all patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who presented with simultaneous bihemispheric ischemic strokes.
resultsOf 637 COVID-19 admissions during the 2-month period, 13 had a diagnosis of acute ischemic stroke, including 5 who developed bihemispheric cerebral infarction. Three of those 5 (60%) were female, median age was 54 (range 41-67), and all five were being managed for severe COVID-19-related pneumonia complicated by acute kidney injury and liver failure before the diagnosis of cerebral infarction was established. Five presented with elevated ferritin, lactate dehydrogenase, and interleukin-6 (IL-6) levels, and four had lymphopenia and elevated D-dimer levels. All patients underwent neuroimaging with computed tomography for persistent depressed mentation, with or without a focal neurologic deficit, demonstrating multifocal ischemic strokes with bihemispheric involvement. Outcome was poor in all patients: two were discharged to a rehabilitation facility with moderate-to-severe disability and three (60%) patients died.
conclusionsStroke is implicated in SARS-CoV-2 infection. Although causality cannot be established, we present the imaging and clinical findings of patients with COVID-19 and simultaneous bihemispheric ischemic strokes. Multifocal ischemic strokes with bihemispheric involvement should be considered in COVID-19 patients with severe infection and poor neurologic status and may be associated with poor outcomes.
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