Younger adults with asymptomatic or minimally symptomatic COVID-19 are at an increased risk for acute ischemic stroke (AIS) during the convalescent phase of the infection, according to study results published in JAMA Network Open.

Previous studies have shown that the risk for AIS is elevated in patients with respiratory symptoms of COVID-19 infection, secondary to an associated coagulopathy. However, limited data exist on the risk for AIS in asymptomatic or minimally symptomatic patients with COVID-19 infection.

The objective of the current study was to explore AIS risk among patients no more than 50 years of age in the convalescent phase of asymptomatic COVID-19 infection.

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Study researchers collected data on 54,485 patients from India and Bangladesh who were working in Singapore and living in dormitories and with laboratory-confirmed asymptomatic COVID-19 infection.

Of the entire cohort, 18 men (median age, 41 years) received care for AIS between May 21, 2020, and October 14, 2020. All patients had no respiratory symptoms during their hospitalization for AIS and were found to be negative on swab testing for COVID-19. The median time from positive serological result to AIS was 54.5 days.

Study researchers identified large vessel occlusion on initial computed tomography or magnetic resonance imaging in 10 patients (56%), including 6 patients that underwent intravenous thrombolysis and/or endovascular therapy. An extensive investigation for potential cause identified a cardiogenic cause of stroke among 3 patients.

Incidence rate was based on the 18 patients with AIS and an at-risk population of 54,485 adults with COVID-19 over a period of 21 weeks. Findings indicated that the annual incidence rate of AIS was 82.6 cases per 100,000 adults. The historical age-, sex, and ethnicity-matched incidence rate of AIS was 38.2 cases per 100,000 adults. Therefore, the annual incidence rate of AIS was more than twice as high among those with asymptomatic COVID-19 patients, compared with the historical controls (rate ratio, 2.16; 95% CI, 1.36-3.48; P <.001).

The study had several limitations, including the observational design, study sample limited to South Asian men, and the annual incidence rate being based on the single case series, requiring cautious interpretation.

“The findings suggest an increased risk of AIS for these patients months after a serological diagnosis. Stroke may be the next wave of complications from COVID-19. Hence, stroke units should be on alert and use serological testing, especially in younger patients or in the absence of traditional risk factors,” concluded the study researchers.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Tu TM, Seet CYH, Koh JS, et al. Acute ischemic stroke during the convalescent phase of asymptomatic COVID-2019 infection in men. JAMA Netw Open. Published online April 22, 2021. doi:10.1001/jamanetworkopen.2021.7498

This article originally appeared on Neurology Advisor