Where in the World Have All the Strokes Gone?

Globally, to date, there have been nearly 125 million confirmed cases of coronavirus disease 2019 (COVID-19) during this pandemic, including >2.7 million deaths, as reported to World Health Organization. Although the common symptoms of COVID-19 are cough, dyspnea, fever, chills, myalgia, anosmia, and ageusia, an increase in several neurologic manifestations, specifically ischemic and hemorrhagic stroke syndromes, has been recognized. Ischemic stroke related to COVID-19 may be secondary to thrombotic microangiopathy, vascular endotheliopathy, arterial dissection, or leukoencephalopathy of the posterior reversible encephalopathy type.1 Hemorrhagic stroke associated with COVID-19 may also be due to intracerebral hemorrhage, subarachnoid hemorrhage, or microbleeds.1 The incidence of stroke during the pandemic was predicted to increase due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus link to both thrombotic and hemorrhagic risk potential.2 Paradoxically, stroke admissions to hospital appeared to decline during the pandemic, speculated to be due to a fear of infection, leading to patients with stroke refusing to call for emergency medical services.2 Scientists called for epidemiologic data to characterize and more clearly understand the effect of the COVID-19 pandemic on stroke care.2,3

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