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Stroke and altered mental state increase risk of death for COVID-19 patients


People hospitalized with COVID-19 and neurological problems including stroke and confusion, have a higher risk of dying than other COVID-19 patients, according to a study published online today by researchers at Montefiore Health System and Albert Einstein College of Medicine in the journal Neurology®, the medical journal of the American Academy of Neurology. These findings have the potential to identify and focus treatment efforts on individuals most at risk and could decrease COVID-19 deaths.

The study looked at data from 4,711 COVID-19 patients who were admitted to Montefiore during the six-week period between March 1, 2020 and April 16, 2020. Of those patients, 581 (12%) had neurological problems serious enough to warrant brain imaging. These individuals were compared with 1,743 non-neurological COVID-19 patients of similar age and disease severity who were admitted during the same period.

“This study is the first to show that the presence of neurological symptoms, particularly stroke and confused or altered thinking, may indicate a more serious course of illness, even when pulmonary problems aren’t severe,” said David Altschul, M.D., chief of the division of neurovascular surgery at Einstein and Montefiore and associate professor in the Leo M. Davidoff Department of Neurological Surgery and of radiology at Einstein. “Hospitals can use this knowledge to prioritize treatment and, hopefully, save more lives during this pandemic.”

Among people who underwent brain imaging, 55 were diagnosed with stroke and 258 people exhibited confusion or altered thinking ability. Individuals with stroke were twice as likely to die (49% mortality) compared with their matched controls (24% mortality) — a statistically significant difference. People with confusion had a 40% mortality rate compared with 33% for their matched controls — also statistically significant.

More than half the stroke patients in the study did not have hypertension or other underlying risk factors for stroke. “This highly unusual finding agrees with other studies of people with COVID-19 in suggesting that infection with the novel coronavirus is itself a risk factor for stroke,” said Dr. Altschul, who is also surgical director of the Montefiore Comprehensive Center for Stroke Care, and the study co- author, along with Emad Eskandar, M.D., M.B.A., chair of neurological surgery at Einstein and Montefiore, professor in the Leo M. Davidoff Department of Neurological Surgery, the department of psychiatry and behavioral sciences, in the Dominick P. Purpura Department of Neuroscience at Einstein. Dr. Eskandar also holds the Jeffrey P. Bergstein Chair and the David B. Keidan Chair in Neurological Surgery.

The paper is titled, “Neurologic Syndromes Predict Higher In-Hospital Mortality in COVID-19.” The senior author was Mark Mehler, M.D., professor and chair of the Saul R. Korey Department of Neurology at Einstein and Montefiore, professor of neuroscience and of psychiatry and behavioral sciences, director of the Institute for Brain Disorders and Neural Regeneration, and the Alpern Family Foundation Chair in Cerebral Palsy Research.

Charles Esenwa, M.D., assistant professor of neurology, and Daniel Labovitz, M.D., associate professor of neurology and of medicine, played a major role in selecting participants for the study.

Additional Einstein-Montefiore authors are: Rafael de La Garza Ramos, M.D., Phillip Cezayirli, M.D., Santiago R Unda, M.D., Joshua Benton, B.A., Joseph Dardick, B.A., Aureliana Toma, M.D., Nikunj Patel, B.A., Avinash Malaviya, B.A., M.S., David Flomenbaum, B.S., Jenelys Fernandez-Torres, B.A., Jenny Lu, B.A., Ryan Holland, M.D., Elisabetta Burchi, M.D., Richard Zampolin, M.D., Kevin Hsu, M.D., Andrew McClelland, M.D., Judah Burns, M.D., Amichai Erdfarb, M.D., Rishi Malhotra, M.D., Michelle Gong, M.D., Peter Semczuk, D.D.S., M.P.H., Victor Ferastraoaru, M.D., Jillian Rosengard, M.D., Daniel Antoniello, M.D., Mark Milstein, M.D., and Alexis Boro, M.D



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