{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T01:57:41Z","timestamp":1793066261194,"version":"4.5.0"},"reference-count":60,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RG\/16\/4\/32218"],"award-info":[{"award-number":["RG\/16\/4\/32218"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/N026896\/1"],"award-info":[{"award-number":["MR\/N026896\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, the relationship between COVID-19 and acute cerebrovascular diseases is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aimed to characterize the incidence, risk factors, clinical\u2013radiological manifestations, and outcome of COVID-19-associated stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three medical databases were systematically reviewed for published articles on acute cerebrovascular diseases in COVID-19 (December 2019\u2013September 2020). The review protocol was previously registered (PROSPERO ID\u2009=\u2009CRD42020185476). Data were extracted from articles reporting \u22655 stroke cases in COVID-19. We complied with the PRISMA guidelines and used the Newcastle\u2013Ottawa Scale to assess data quality. Data were pooled using a random-effect model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary of review<\/jats:title>\n                    <jats:p>Of 2277 initially identified articles, 61 (2.7%) were entered in the meta-analysis. Out of 108,571 patients with COVID-19, acute CVD occurred in 1.4% (95%CI: 1.0\u20131.9). The most common manifestation was acute ischemic stroke (87.4%); intracerebral hemorrhage was less common (11.6%). Patients with COVID-19 developing acute cerebrovascular diseases, compared to those who did not, were older (pooled median difference\u2009=\u20094.8 years; 95%CI: 1.7\u201322.4), more likely to have hypertension (OR\u2009=\u20097.35; 95%CI: 1.94\u201327.87), diabetes mellitus (OR\u2009=\u20095.56; 95%CI: 3.34\u20139.24), coronary artery disease (OR\u2009=\u20093.12; 95%CI: 1.61\u20136.02), and severe infection (OR\u2009=\u20095.10; 95%CI: 2.72\u20139.54). Compared to individuals who experienced a stroke without the infection, patients with COVID-19 and stroke were younger (pooled median difference\u2009=\u2009\u22126.0\u00a0years; 95%CI: \u221212.3 to \u22121.4), had higher NIHSS (pooled median difference\u2009=\u20095; 95%CI: 3\u20139), higher frequency of large vessel occlusion (OR\u2009=\u20092.73; 95%CI: 1.63\u20134.57), and higher in-hospital mortality rate (OR\u2009=\u20095.21; 95%CI: 3.43\u20137.90).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Acute cerebrovascular diseases are not uncommon in patients with COVID-19, especially in those whom are severely infected and have pre-existing vascular risk factors. The pattern of large vessel occlusion and multi-territory infarcts suggests that cerebral thrombosis and\/or thromboembolism could be possible causative pathways for the disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1747493020972922","type":"journal-article","created":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T06:23:17Z","timestamp":1603693397000},"page":"137-149","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":487,"title":["Stroke in COVID-19: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1825-1874","authenticated-orcid":false,"given":"Stefania","family":"Nannoni","sequence":"first","affiliation":[{"name":"Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"de Groot","sequence":"additional","affiliation":[{"name":"Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Bell","sequence":"additional","affiliation":[{"name":"Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh S","family":"Markus","sequence":"additional","affiliation":[{"name":"Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,11,11]]},"reference":[{"key":"bibr1-1747493020972922","unstructured":"COVID-19 Situation Report-104 by the WHO, https:\/\/covid19.who.int (2020, accessed 22 August 2020)."},{"key":"bibr2-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1585"},{"key":"bibr3-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2020.02.017"},{"key":"bibr4-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1177\/1747493020923472"},{"key":"bibr5-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2020-323586"},{"key":"bibr6-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104984"},{"key":"bibr7-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104949"},{"key":"bibr8-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1177\/1747493020921664"},{"key":"bibr9-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-09990-2"},{"key":"bibr10-1747493020972922","doi-asserted-by":"crossref","unstructured":"Romoli M, Jelcic I, Bernard-Valnet R, et\u00a0al. A systematic review of neurological manifestations of SARS-CoV-2 infection: the devil is hidden in the details.\n                      Eur J Neurol\n                      2020; 27: 1712\u20131726. DOI: 10.1111\/ene.14382.","DOI":"10.1111\/ene.14382"},{"key":"bibr11-1747493020972922","first-page":"1","volume":"23","author":"Taherifard E","year":"2020","journal-title":"Neurol Res"},{"key":"bibr12-1747493020972922","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"bibr13-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2535"},{"key":"bibr14-1747493020972922","unstructured":"Wells GA SB, O\u2019Connell D, et\u00a0al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp (2019, accessed 22 August 2020)."},{"key":"bibr15-1747493020972922","first-page":"69","volume":"62","author":"McGrath S","year":"2020","journal-title":"Biomed J"},{"key":"bibr16-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1002\/sim.8013"},{"key":"bibr17-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/26.4.404"},{"key":"bibr18-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2020-000431"},{"key":"bibr19-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2020.04.041"},{"key":"bibr20-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2020.116969"},{"key":"bibr21-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.1127"},{"key":"bibr22-1747493020972922","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1007\/s10072-020-04547-7","volume":"41","author":"Karada\u015f \u00d6","year":"2020","journal-title":"Neurol Sci"},{"key":"bibr23-1747493020972922","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00806"},{"key":"bibr24-1747493020972922","doi-asserted-by":"crossref","unstructured":"Merkler AE, Parikh NS, Mir S, et\u00a0al. Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza.\n                      JAMA Neurol\n                      2020. doi:10.1001\/jamaneurol.2020.2730.","DOI":"10.1001\/jamaneurol.2020.2730"},{"key":"bibr25-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2009787"},{"key":"bibr26-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030397"},{"key":"bibr27-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030335"},{"key":"bibr28-1747493020972922","doi-asserted-by":"crossref","unstructured":"Escalard S, Chalumeau V, Escalard C, Redjem H, Delvoye F, H\u00e9bert S, et\u00a0al. Early brain imaging shows increased severity of acute ischemic strokes with large vessel occlusion in COVID-19 patients.\n                      Stroke\n                      2020; 51: 3366\u20133370.","DOI":"10.1161\/STROKEAHA.120.031011"},{"key":"bibr29-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1177\/1747493020937189"},{"key":"bibr30-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2020-016220"},{"key":"bibr31-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1159\/000509581"},{"key":"bibr32-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1159\/000508958"},{"key":"bibr33-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbih.2020.100092"},{"key":"bibr34-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-020-02228-y"},{"key":"bibr35-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030791"},{"key":"bibr36-1747493020972922","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.01031"},{"key":"bibr37-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-09974-2"},{"key":"bibr38-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030153"},{"key":"bibr39-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1177\/1747493020943815"},{"key":"bibr40-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1007\/s12975-020-00818-9"},{"key":"bibr41-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14578"},{"key":"bibr42-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2007575"},{"key":"bibr43-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2012-7"},{"key":"bibr44-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30937-5"},{"key":"bibr45-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1007\/s12975-020-00818-9"},{"key":"bibr46-1747493020972922","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9051417"},{"key":"bibr47-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30183-5"},{"key":"bibr48-1747493020972922","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9061651"},{"key":"bibr49-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2020-317025"},{"key":"bibr50-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.016793"},{"key":"bibr51-1747493020972922","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S251173"},{"key":"bibr52-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.05.006"},{"key":"bibr53-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2008597"},{"key":"bibr54-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2020.116980"},{"key":"bibr55-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.05.015"},{"key":"bibr56-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmni.2020.100669"},{"key":"bibr57-1747493020972922","doi-asserted-by":"publisher","DOI":"10.18632\/aging.103335"},{"key":"bibr58-1747493020972922","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2020201187"},{"key":"bibr59-1747493020972922","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A6595"},{"key":"bibr60-1747493020972922","doi-asserted-by":"crossref","unstructured":"Conklin J, Frosch MP, Mukerji S, et\u00a0al. Cerebral microvascular injury in severe COVID-19.\n                      medRxiv\n                      Preprint. 2020 Jul 24. doi: 10.1101\/2020.07.21.20159376.","DOI":"10.1101\/2020.07.21.20159376"}],"container-title":["International Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1747493020972922","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1747493020972922","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1747493020972922","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T07:19:20Z","timestamp":1777706360000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1747493020972922"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,11]]},"references-count":60,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1177\/1747493020972922"],"URL":"https:\/\/doi.org\/10.1177\/1747493020972922","relation":{},"ISSN":["1747-4930","1747-4949"],"issn-type":[{"value":"1747-4930","type":"print"},{"value":"1747-4949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,11]]}}}