key: cord-314107-x6e1jhcd authors: Walker, M.; Young, C. C.; Sharma, M.; Levitt, M. R.; Tirschwell, D. L.; Investigators, WWAMI Stroke title: SARS-CoV-2 Infection and Stroke: Coincident or Causal? date: 2020-07-29 journal: nan DOI: 10.1101/2020.07.17.20156463 sha: doc_id: 314107 cord_uid: x6e1jhcd Neurological manifestations of SARS-CoV-2 infection described in isolated case reports and single institutions do not accurately reflect the clinical spectrum of disease across all geographies in a global pandemic. Data collected during peak of the Covid-19 pandemic from stroke centers in five states reveal few similarities to what has recently been published. Given the diversity in phenotype, we caution policymakers and health care providers when considering cerebrovascular complications from SARS-CoV-2 infection. An associated hypercoagulable state has been implicated as the cause for stroke in as many as 5.9% of severely infected patients in Wuhan, China [1] , 0.9% of patients hospitalized patients in a New York City hospital system [2] , and as an unusually common presentation for young adults in New York City [3] . None of these findings were substantiated in a population of 11.8 million people across the five-state (Washington, Wyoming, Alaska, Montana, and Idaho [WWAMI] region in the United States. Nineteen of twenty-one nationally or state certified thrombectomy capable stroke centers in the WWAMI region provided data on stroke admissions and mechanical thrombectomies performed during March and April 2020 and March and April 2019 (Table 1) . With the exception of Wyoming, all states were under shelter-in-place or stay-at-home mandate during this period of time. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 29, 2020. . https://doi.org /10.1101 /10. /2020 (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 29, 2020. . https://doi.org /10.1101 /10. /2020 underwent mechanical thrombectomy and two were under the age of 50. There were no reports of venous sinus thrombosis in SARS-CoV-2 patients. Consistent with global reports, we observed a regional reduction in overall stroke volume during the COVID-19 pandemic peak. Surprisingly, less than 0.1% of patients suffered coincident SARS-CoV-2 infection and ischemic stroke. We also found no association between SARS-CoV-2 infection and stroke in younger patients. Though the total number of ischemic stroke patients decreased, likely due to social distancing and changes in health-seeking behavior, the number of large vessel occlusions requiring thrombectomy was not significantly different. Our results suggest striking differences in the effects of COVID-19 on the presentation of ischemic stroke. The pathophysiological basis for these differences is unknown, and potentially related to differences in geography, viral strain, or other yet unidentified factor(s). Similarly, a retrospective review in the UK during this same period [4] failed to identify a causal relationship in six patients with large vessel strokes and coincident SARS-CoV-2 infection because competing vascular risk factors were present. Regional data from five U.S. states suggests that among patients who sought care or were hospitalized during the peak of COVID-19, acute ischemic stroke in the setting of SARS-CoV-2 infection is rare and may be coincident. Further study is necessary, and we caution clinicians making major clinical decisions based on isolated case reports involving single institutions. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 29, 2020. . https://doi.org /10.1101 /10. /2020 Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease SARS2-CoV-2 and Stroke in a New York Healthcare System Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young Characteristics of ischaemic stroke associated with COVID-19