Characteristics of Acute Stroke in Patients with Coronavirus Disease 2019 and Challenges in Stroke Management during an Epidemic

다국어 초록 (Multilingual Abstract)

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic infection associated with high morbidity and mortality. The Korean city of Daegu endured the first large COVID-19 outbreak outside of China. Since the report of the first confirmed case in Daegu on February 18, 2020, a total of 6,880 patients have been reported until May 29, 2020. We experienced five patients with ischemic stroke and COVID-19 during this period in four tertiary hospitals in Daegu. The D-dimer levels were high in all three patients in whom D-dimer blood testing was performed.
Multiple embolic infarctions were observed in three patients and suspected in one. The mean time from stroke symptom onset to emergency room arrival was 22 hours. As a result, acute treatment for ischemic stroke was delayed. The present case series report raises the possibility that the coronavirus responsible for COVID-19 causes or worsens stroke, perhaps by inducing inflammation. The control of COVID-19 is very important; however, early and proper management of stroke should not be neglected during the epidemic.

참고문헌 (Reference)

1 김범준, "Management of Acute Stroke Patients Amid the Coronavirus Disease 2019 Pandemic: Scientific Statement of the Korean Stroke Society" 대한뇌졸중학회 22 (22): 203-205, 2020

2 Oxley TJ, "Large-vessel stroke as a presenting feature of Covid-19 in the young" 382 (382): e60-, 2020

3 Jun Yup Kim, "Executive Summary of Stroke Statistics in Korea 2018: A Report from the Epidemiology Research Council of the Korean Stroke Society" 대한뇌졸중학회 21 (21): 42-59, 2019

4 Baig AM, "Evidence of the COVID-19 virus targeting the CNS : tissue distribution, host-virus interaction, and proposed neurotropic mechanisms" 11 (11): 995-998, 2020

5 Zu ZY, "Coronavirus disease 2019(COVID-19) : a perspective from China" 296 (296): E15-E25, 2020

6 Ministry of the Interior and Safety, "Coronavirus Disease-19, Republic of Korea"

7 Jin H, "Consensus for prevention and management of coronavirus disease 2019(COVID-19)for neurologists" 5 (5): 146-151, 2020

8 Eu Suk Kim, "Clinical Course and Outcomes of Patients with Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Preliminary Report of the First 28 Patients from the Korean Cohort Study on COVID-19" 대한의학회 35 (35): 1-12, 2020

9 Sung Ho Kyung, "Clinical Course and Outcomes of 3,060 Patients with Coronavirus Disease 2019 in Korea, January–May 2020" 대한의학회 35 (35): 1-11, 2020

10 Beyrouti R, "Characteristics of ischaemic stroke associated with COVID-19" 91 (91): 889-891, 2020

11 Hess DC, "COVID-19-related stroke" 11 (11): 322-325, 2020

12 Bikdeli B, "COVID-19 and thrombotic or thromboembolic disease : implications for prevention, antithrombotic therapy, and follow-up : JACC State-of-the-Art Review" 75 (75): 2950-2973, 2020

13 Tang N, "Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy" 18 (18): 1094-1099, 2020