Features of etiopathogenetic factors and course of stroke after coronavirus infection

Disorder of coronary circulation is one of the most severe complications of COVID‑19. Strokes that develop against the background of coronavirus infection are more often associated with occlusion of large vessels and have a more severe course. The frequency of strokes associated with COVID‑19, according to different authors, ranges from 1 to 6 %.

Objective. To analyze the etiopathogenetic factors, the course of stroke after a coronavirus infection, and to analyze the possible relationship between the severity of COVID‑19 and the severity of stroke.

Materials and methods. Observation of 110 patients of the neurological department of the First Republican Clinical Hospital of Udmurtia for the period from 2020 to 2021 with confirmed ischemic or hemorrhagic stroke associated with COVID‑19. Statistical data processing was carried out in Microsoft Excel 2013, MedCalc.

Results. Hypertension, atherosclerosis, and cardiac arrhythmia predominated in the structure of comorbidities in the examined patients. In 88.0 % of cases, ischemic stroke was observed in patients after infection, mainly the lesion concerned the carotid basin (55.5 %). Patients more often had focal neurological symptoms, among which hemiparesis and hemiplegia prevailed. Features of the results of laboratory diagnostics is the presence of coagulopathy, renal and hepatic insufficiency: increased levels of fibrinogen, D-dimers, creatinine, urea, proteinuria. According to neuroimaging data, in 54.5 % of cases, the stroke focus was more than 15 mm; duplex scanning of vessels in 95.0 % of cases revealed signs of atherosclerosis of the brachiocephalic arteries, carotid arteries in 54.5 % of cases. Correlation analysis revealed the relationship between the severity of COVID‑19 and the clinical manifestations of stroke. Most of the strokes occurred in the subjects within 1–6 months (40.9 %) after suffering COVID‑19.

Conclusion. In the development of stroke after suffering COVID‑19, coagulopathy, renal liver failure, cardiovascular comorbidities, especially hypertension, and atherosclerosis play a significant role. Stroke severity is correlated with the severity of COVID‑19.

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