Risk of Acute Ischemic Stroke in Patients 65 and Older Is Early After COVID-19 Diagnosis

Associated acute and long-term medical complications of COVID-19 beyond respiratory illness include acute ischemic stroke (AIS).(1-5) Hypercoagulability, inflammation, cardiac dysfunction, and endothelial inflammation that occur during the infectious phase can lead to thrombotic events and thus cerebral ischemia.(6) Reported risks of stroke in COVID-19 have varied substantially across studies.(7) Most studies have focused on AIS incidence in patients diagnosed during or upon hospitalization. Unlike any other infectious disease in modern times and as a result of the need to trace and monitor for outbreaks to prevent the spread of COVID-19, a very large number of patients have been screened for COVID-19 at the time of hospital admission. This screening has identified both asymptomatic and symptomatic individuals with COVID-19, thus making it more difficult to determine whether and in whom COVID-19 may increase the risk of AIS and whether the association is true or incidental. In this issue of Neurology (R), Yang et al.(8) evaluated the estimated incidence rate ratio of AIS after COVID-19 infection in a known high-risk group-patients older than 65-and determined the time frame of highest risk of AIS associated with COVID-19 within this population.(8)