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Editorial commentary
Ischaemic stroke can follow COVID-19 vaccination but is much more common with COVID-19 infection itself
  1. Hugh S Markus
  1. Department of Clinical Neurosciences, Cambridge University, Cambridge CB2 1TN, UK
  1. Correspondence to Professor Hugh S Markus, Department of Clinical Neurosciences, Cambridge University, Cambridge CB2 1TN, UK; hsm32{at}medschl.cam.ac.uk

https://doi.org/10.1136/jnnp-2021-327057

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    Thrombotic complications occurring as part of COVID-19 related vaccine-induced immune thrombotic thrombocytopaenia (VITT) can include ischaemic stroke as well as cerebral venous thrombosis

    The COVID-19 pandemic has had a major impact on stroke. While there was marked drop in hospitalised stroke cases worldwide particularly during the first wave,1 2 epidemiological data have shown a real increase in stroke incidence with cases primarily occurring out of hospital and especially in care homes.3 Therefore, COVID-19 infection itself is a risk factor for stroke, and a recent systematic review reported it occured in 1.4% of COVID-19 infections.4 A characteristic pattern is found with increased large artery occlusion, and an increased proportion of cryptogenic strokes often affecting multiple arterial territories, while small artery stroke is less common.4 Both stroke severity and mortality are increased compared with non-COVID-19 related stroke. A major factor underlying this increased risk is …

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    Footnotes

    • Twitter @Camstroke

    • Contributors only my work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.

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