Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19: Results of a retrospective multicenter neuroimaging-based study from three central European countries

Ulf Jensen-Kondering*, Christoph J. Maurer, Hanna C.B. Brudermann, Marielle Ernst, Sam Sedaghat, Nils G. Margraf, Thomas Bahmer, Olav Jansen, Jawed Nawabi, Estelle Vogt, Laura Büttner, Eberhard Siebert, Michael Bartl, Volker Maus, Gregor Werding, Marc Schlamann, Nuran Abdullayev, Benjamin Bender, Vivien Richter, Annerose MengelSiri Göpel, Ansgar Berlis, Astrid Grams, Valentin Ladenhauf, Elke R. Gizewski, Philipp Kindl, Victor Schulze-Zachau, Marios Psychogios, Inke R. König, Stefan Sondermann, Sönke Wallis, Norbert Brüggemann, Peter Schramm, Alexander Neumann

*Corresponding author for this work
2 Citations (Scopus)


Background: Coronavirus disease 2019 (COVID-19) is an infection which can affect the central nervous system. In this study, we sought to investigate associations between neuroimaging findings with clinical, demographic, blood and cerebrospinal fluid (CSF) parameters, pre-existing conditions and the severity of acute COVID-19. Materials and methods: Retrospective multicenter data retrieval from 10 university medical centers in Germany, Switzerland and Austria between February 2020 and September 2021. We included patients with COVID-19, acute neurological symptoms and cranial imaging. We collected demographics, neurological symptoms, COVID-19 severity, results of cranial imaging, blood and CSF parameters during the hospital stay. Results: 442 patients could be included. COVID-19 severity was mild in 124 (28.1%) patients (moderate n = 134/30.3%, severe n = 43/9.7%, critical n = 141/31.9%). 220 patients (49.8%) presented with respiratory symptoms, 167 (37.8%) presented with neurological symptoms first. Acute ischemic stroke (AIS) was detected in 70 (15.8%), intracranial hemorrhage (IH) in 48 (10.9%) patients. Typical risk factors were associated with AIS; extracorporeal membrane oxygenation therapy and invasive ventilation with IH. No association was found between the severity of COVID-19 or blood/CSF parameters and the occurrence of AIS or IH. Discussion: AIS was the most common finding on cranial imaging. IH was more prevalent than expected but a less common finding than AIS. Patients with IH had a distinct clinical profile compared to patients with AIS. There was no association between AIS or IH and the severity of COVID-19. A considerable proportion of patients presented with neurological symptoms first. Laboratory parameters have limited value as a screening tool.

Original languageEnglish
JournalJournal of Neurology
Issue number5
Pages (from-to)2349-2359
Number of pages11
Publication statusPublished - 05.2023

Research Areas and Centers

  • Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)

DFG Research Classification Scheme

  • 206-07 Clinical Neurology Neurosurgery and Neuroradiology

Coronavirus related work

  • Research on SARS-CoV-2 / COVID-19

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