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Consider alternative causes before allocating acute ischaemic stroke to COVID-19
  1. Josef Finsterer
  1. Neurology & Neurophysiology Center, Vienna, Austria
  1. Correspondence to Dr Josef Finsterer, Neurology & Neurophysiology Center, 1180 Vienna, Austria; fifigs1{at}

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We read with interest the excellent article by Dmytriw et al reported on a retrospective, multicenter cohort study of patients with COVID-19 with acute ischaemic stroke (AIS) admitted to stroke units in the USA and Canada between March and August 2020.1 The primary endpoint was a modified Rankin Scale (mRS) of 5–6 and the secondary endpoints were an mRS<3, ordinal RS, symptomatic intracerebral haemorrhage and complications during hospitalisation.1 It has been established that there may be an association between COVID-19-associated AIS and severe outcome or death, and that the neutrophil to lymphocyte ratio predicts morbidity and mortality.1 The study is attractive but raises concerns that need to be discussed.

A limitation of the study is that cardiogenic sources of AIS …

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  • Contributors The author was resposible for all required issues.

  • Funding The author has 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 Not commissioned; internally peer reviewed.