ABSTRACT
Background and aims: The impact of the COVID-19 pandemic during the first wave in Italy caused a decrease of hospital admissions, delays in reperfusion treatments and an overall worse outcome in COVID+ patients with stroke. However, few data are available on outcome of stroke stratified by gender. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted in 19 Neurology Units by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to Neurological units between March-April 2020 with ischaemic stroke were recruited. Demographic, clinical, treatment and outcome data were compared in patients with (COVID19+) and without COVID-19 (COVID19-), as well as in male and female patients. Results: 812 patients with ischemic stroke were enrolled (682 COVID-, 129 COVID+);males were 54.1% and 52.7%. Intra-hospital mortality was 31.9% in COVID+ patients (38.6% in male and 27.8% in female) and 7.2% in COVID- (8.4% in males and 6% in females). Male patients with COVID+ were more likely to have cPAP (30.9% vs 14.8%;p=0.03) or being intubated (14.9% vs 3.3%;p=0.02) than females. Reperfusion treatment was administered more frequently in women if COVID- (34.5% vs 29.8%), while less frequently if COVID+ (11.5% vs 29.4%;p=0.01). COVID+ patients had a higher frequency of ESUS than COVID- (31.8% vs 22.3%;p=0.02), with a higher frequency in COVID+ females compared to males (36.1% vs 27.9%). Conclusion: Our study detected some differences due to gender in ischaemic stroke with and without COVID-19. Multivariate analyses is ongoing to define predictors of mortality across gender categories.
ABSTRACT
Background and aims: The number of cases of encephalitis in COVID-19 pandemic is increasing. We describe characteristics and outcome of encephalitis in COVID-19 (COV-ENC) patients in one of the most affected regions by COVID-19 of the world, Lombardia, during the first pandemic wave. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to 20 Neurological Departments in Lombardia between February-April 2020 with COV-ENC have been included. Results: 30 COV-ENC patients had a mean age of 66.5 years and male frequency of 56.6%. Altered consciousness was characterized by confusion in 86%, coma in 30%, delirium in 37.9% and alteration of personality traits in 27.6%. Epileptic seizures occurred in 74% of cases. One third of cases had hyperproteinorrachia, one third pleocytosis/hyperproteinorrachia, and remaining third had a normal CSF. PCR for SARS-CoV-2 was negative in all tested patients. EEG was altered in 82.7% of patients. Brain CT and MRI were normal in 9 patients, and among abnormal findings 9 patients had mesial temporal lesions, one of which confirmed with PET imaging. The course was favorable in 39.2% of patients, sequelae were few in 26.6% and moderate in 19.2%, while 20% of patients died. Conclusions: The outcome tends to be worse in male patients. PCR negativity seems to confirm an autoimmune etiology more than a direct invasion of the virus. However, a temporal lobe involvement, detected in 30% of patients with COV-ENC, suggests usual sites of encephalitis due to herpes virus.
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Background and aims: Mounting data has been published as to the impact of SARS-CoV-2 on cerebrovascular events, particularly on ischemic strokes. Our study addresses the clinical course of patients with cerebral haemorrhage and simultaneous SARS-CoV-2 infection, paying particular attention to both SARS-CoV-2 positive and negative patients hospitalized during the pandemic. Methods: The Italian Society of Hospital Neurosciences (SNO) promoted a multicentre, retrospective, observational study (SNO-COVID-19), involving 20 Neurology Units in Northern Italy. Data were collected on patients consecutively admitted to neurological departments, from March 1st to April 30th with cerebrovascular diseases, occurring either at home or during hospitalization for other causes. Results: 949 patients were enrolled (average age 73.4 years;52.7% males);135 patients had haemorrhagic stroke and 127 (13.4%) had a primary ICH. Only 16 patients with ICH (12.6%) had laboratory confirmed SARS-CoV-2 infection, clinically expressed or not. SARS-CoV-2 related pneumonia or respiratory distress, lobar location and previous antiplatelet or anticoagulant treatment were the only factors significantly associated with increased mortality in ICH. SARS-CoV-2 infection, regardless of respiratory involvement, led to a nonsignificantly increased risk of in-hospital death. Conclusion: Our study confirms that age, ICH location and previous antiplatelet or anticoagulant treatment are predictors of in-hospital death. Unlike ischemic stroke, ICH in SARS-CoV-2 patients led only to a slight increase in mortality, mainly due to respiratory involvement.
ABSTRACT
Background: The coronavirus disease of 2019 (Covid-19) represents an unprecedented threat for human health worldwide that may have profound stress effects. Pregnancy is a sensitive period for adverse parenting effects on infants’ development and epigenetic mechanisms (DNA methylation) may play a pivotal role. Here we present the study protocol of the MOM-COPE project. Methods: Mothers and infants will be enrolled in twelve neonatal units in Northern Italy, a dramatic hotspot for Covid-19 contagion in Europe. Maternal covid-related stress will be assessed with an ad-hoc questionnaire. At birth, newborns and mothers’ salivary samples will be obtained to estimate target genes’ methylation (BDNF, FKBP5, NR3C1, SLC6A4, and OXTR). Post-natal bonding and infants’ temperament will be assessed through maternal reports at 3, 6 and 12 months. Maternal sensitivity and infants’ emotional regulation will be assessed during remote videotaped mother-infant interaction at 12 months. Results: The study has obtained approval of the Ethics Committee and is going to start by May 15th. Hypotheses and anticipated results will be discussed according to the available behavioral epigenetic literature on parenting, pregnancy and large-scale disasters. Discussion: This multi-centric study will provide evidence about the effect of pandemic-related prenatal stress exposure on the health and well-being of mothers and infants from birth to 12 months of age. Moreover, the longitudinal nature of the study will allow to assess the relative role of epigenetic regulation of specific target genes in mediating the effect of this precocious adverse exposure on short- and long-term outcomes.
ABSTRACT
BACKGROUND AND PURPOSE: Comorbidity of acute ischaemic stroke with Covid-19 is a challenging condition, potentially influencing the decision of whether to administer intravenous thrombolysis (IVT). We aimed to assess the 1-month outcome in ischaemic stroke patients with Covid-19 infection who received IVT alone or before thrombectomy (bridging therapy). METHODS: As a collaboration initiative promoted by the Italian Stroke Organization, all Italian stroke units (n = 190) were contacted and invited to participate in data collection on stroke patients with Covid-19 who received IVT. RESULTS: Seventy-five invited centers agreed to participate. Thirty patients received IVT alone and 17 received bridging therapy between 21 February 2020 and 30 April 2020 in 20 centers (n = 18, Northern Italy; n = 2, Central Italy). At 1 month, 14 (30.4%) patients died and 20 (62.5%) survivors had a modified Rankin Scale (mRS) score of 3 to 5. At 24 to 36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in eight (17.4%) patients and symptomatic ICH (sICH) in two (4.3%) patients. Causes of death were severe ischaemic stroke (n = 8), a new ischaemic stroke (n = 2), acute respiratory failure (n = 1), acute renal failure (n = 1), acute myocardial infarction (n = 1), and endocarditis (n = 1). In survivors with a 1-month mRS score of 3 to 5, baseline glucose level was higher, whereas endovascular procedure time in cases of bridging therapy was longer. Baseline National Institutes of Health Stroke Scale glucose and creatinine levels were higher in patients who died. CONCLUSIONS: Intravenous thrombolysis for patients with stroke and Covid-19 was not a rare event in the most affected areas by pandemic, and rates of 1-month unfavorable outcomes were high compared to previous data from the pre-Covid-19 literature. However, risk of sICH was not increased.