Ischemic Stroke Risk May Be Higher in COVID-19 vs Influenza

Diffusion MRI of the brain, axial section, showing left cerebrovascular ischemia 5 hours after a stroke in a 60 year oldmale patient. The FLAIR (left), diffusion (middle), and app arent diffusion coefficient (ADC; right) sequence images show an ischemic area around the left middle cerebral artery, corresponding to an interruption in blood circulation.
Patients hospitalized with coronavirus disease 2019 had higher rates of ischemic stroke than those of patients with influenza.

Patients hospitalized with coronavirus disease 2019 (COVID-19) had higher rates of ischemic stroke those of patients with influenza, according to study results published in JAMA Neurology.

The rates of ischemic stroke were compared between patients who presented to the emergency room or who were admitted to 2hospitals in New York City for either COVID-19 or influenza. Patients were aged ≥18 years with laboratory-confirmed influenza A/B or COVID-19 infection as confirmed by evidence of severe acute respiratory syndrome coronavirus 2 in the nasopharynx by polymerase chain reaction.

Of the 3402 patients with either COVID-19 or influenza in the emergency room or admitted to the hospital, 1916 had COVID-19 while 1486 had influenza. The rates of ischemic stroke were 1.6% in patients with COVID-19, while ischemic stroke occurred in 0.2% of patients with influenza. After adjustment for age, sex, and race, the likelihood of stroke remained higher with COVID-19 infection than with influenza infection (odds ratio, 7.6; 95% CI, 2.3-25.2).

“These findings suggest that clinicians should be vigilant for symptoms and signs of acute ischemic stroke in patients with COVID-19 so that time-sensitive interventions, such as thrombolysis and thrombectomy, can be instituted if possible to reduce the burden of long-term disability,” the researchers wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Merkler AE, Parikh NS, Mir S, et al. Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza [published online July 2, 2020]. JAMA Neurol. doi:10.1001/jamaneurol.2020.2730