Characteristics and outcomes amongst stroke patients in symptomatic and asymptomatic COVID-19: a systematic review

Introduction: Stroke has been reported in symptomatic and asymptomatic COVID-19 patients with undetermined characteristics and outcomes. Stroke is one of the non-respiratory pathology reported amongst COVID-19 patients with various manifestations. We elucidated the characteristics and outcomes in symptomatic and asymptomatic COVID-19 patients. Methods: A systematic review was performed from 01/01/2020 to 16/03/2022 in EBSCOhost, Google Scholar, Pubmed, Scopus, and Web of Science with search terms, i.e., COVID-19, Coronavirus, SARS-CoV-2, Coronavirus Disease-19, stroke, CVA (cerebrovascular accident), brain MRI, head MRI, magnetic resonance imaging, antithrombotic agent, thrombectomy, using the PRISMA guidelines. Inclusion criteria include case reports or series of adult stroke patients with confirmed COVID-19 written in English; other articles were excluded. Results: From 239 articles screened initially, 23 articles were included. Twenty-five patients are classified as symptomatic (n=17) and asymptomatic (n=8). In symptomatic patients, motor and sensory abnormalities with loss of consciousness and alteration of memory were detected. Eight symptomatic patients had elevated D-dimer, and 2 had elevated fibrinogen levels. Complete resolution was found 6 times higher in symptomatic vs. asymptomatic cases, while the mortality rate was lower in symptomatic compared to asymptomatic patients. Conclusions: Stroke in symptomatic patients occurred more frequently than the asymptomatic and was observed pre-or post-diagnosis of COVID-19; thus could be the comorbidity and/ or complication.