COVID-19 Ischemic Strokes as an Emerging Rehabilitation Population: A Case Series

Diaz-Segarra, Nicole; Edmond, Arline; Kunac, Anastasia; Yonclas, Peter

There is emerging literature that coronavirus disease of 2019 (COVID-19) infections result in an increased incidence of thrombosis secondary to a prothrombotic state. Initial studies reported ischemic strokes primarily occurring in the critically ill COVID-19 population. However, there have been reports of ischemic strokes as the presenting symptom in young non-critically ill COVID-19 patients without significant risk factors. Further characterization of the COVID-19 stroke population is needed. We present four cases of COVID-19 ischemic strokes occurring in patients 37 to 68 years of age with varying COVID-19 infection severities, premorbid risk factors, clinical presentations (e.g. focal and non-focal), and vascular distributions. These cases highlight the heterogeneity of COVID-19 ischemic strokes. The duration of the COVID-19 related prothrombotic state is unknown and it is unclear if patients are at risk for recurrent strokes. With more COVID-19 patients recovering and being discharged to rehabilitation, physiatric awareness of this prothrombotic state and increased incidence of ischemic strokes is essential. Due to the variable presentation of COVID-19 ischemic strokes, clinicians can consider neuroimaging as part of the evaluation in COVID-19 patients with either acute focal or non-focal neurologic symptoms. Additional studies are needed to clarify prothrombotic state duration, determine prognosis for recovery, and establish the physiatrist’s role in long term disease management.