COVID-19 Respiratory Illness and Subsequent Cerebrovascular Events, the Initial Iranian Experience

Behnam Sabayan, Mohsen Moghadami, Farhad Assarzadegan, Sahar Hojjat Anasri Komachali, Leila Poorsaadat, Zabihollah Babaeepour, Seyed Amir Ebrahimzadeh, Ava Hamidi, Zeinab Sadat Hasheminejad, Elahe Mohammadi-Vosough, Hamid Reza Mirkarimi, Sepideh Paybast, Nasrin Rahimian, Anahid Safari, Mersedeh Sepehrnia, Reza Nematollahi, Reza Bavarsad Shahripour, Ayush Batra, Farzaneh Sorond, Afshin Borhani-Haghighi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objectives: COVID-19 disproportionately affects older adults and individuals with cardiovascular co-morbidities. This report presents fifteen patients who had COVID-19 respiratory illness followed by cerebrovascular events. Materials and Methods: A call by the Iranian Neurological Association gathered cases across the country who developed neurological symptoms attributed to hemorrhagic or ischemic stroke after a definite or probable Covid-19 respiratory illness. Definite cases were those with a typical respiratory illness, positive nasopharyngeal Covid-19 PCR test, and chest CT consistent with Covid-19 infection. Probable cases were defined by a typical respiratory illness, history of contacts with a Covid-19 case, and chest CT characteristic for Covid-19 infection. Results: Fifteen patients (12 men and 3 women) with an age range of 38 to 93 years old (median: 65 years old) were included. Fourteen patients had a first-ever acute ischemic stroke and one patient had a subarachnoid hemorrhage. Eleven patients (73%) had previous cardiovascular comorbidities. The median time between respiratory symptoms and neurological symptoms was seven days (range 1-16 days). Stroke severity in two patients was mild (NIHSS ≤ 6), in six patients moderate (NIHSS: 7-12), and in seven patients severe (NIHSS ≥13). One patient received intravenous tissue plasminogen activator ( IV-tPA) with improved neurological symptoms. Six out of 15 patients (40%) died. All but one of those who survived had significant disability assessed by a modified ranking scale >2. The majority of patients in this case series had vascular risk factors and their stroke was associated with severe disability and death. Conclusion: This report highlights the need for further investigation of the links between Covid-19 and cerebrovascular events.

Original languageEnglish (US)
Article number105454
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number1
StatePublished - Jan 2021


  • Brain
  • COVID-19
  • Cerebrovascular accident
  • SARS-CoV-2
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Rehabilitation
  • Surgery


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