ABSTRACT
Objective: NA Background: COVID-19 infection has been associated with a state of hypercoagulability. The hypercoagulability typically presents as a Deep Venous thrombus or Pulmonary Embolism but rarely can manifest as CVST even after recovery from the original COVID-19 infection. Case Report: 27-year-old Caucasian female who had a COVID-19 infection 2 weeks prior, presented with 4 days of persistent headaches associated with nausea and vomiting. Patient also had episodes of rightward gaze without loss of awareness. No prior history of seizures. NIHStrokeScale was 0. CT head showed a hyper density within the sylvian fissure and the sulci of the right temporal and right lateral frontal lobes suggestive of subarachnoid hemorrhage(SAH);CTA head showed cerebral venous sinus thrombosis(CVST) involving straight sinus, most of vein of Gale, right transverse and right sigmoid sinuses that was also seen on MR venogram. MRI brain showed illdefined edema in a distribution concerning for venous infarct due to CVST. CTA chest also showed multiple bilateral pulmonary emboli. EEG showed focal slowing in the right hemisphere and no epileptiform discharges. Patient was started on heparin and transitioned to Dabigatran on discharge. Past medical history was remarkable for Wolf-Parkinson-White syndrome (s/p ablation), obesity and depression. Patient has no personal or family history of hypercoagulability or malignancy. Patient reported birth control use which she stopped 3 weeks prior to this presentation. Patient stopped cigarette smoking 5 years ago. Patient has a healthy 2.5-year-old son and has no history of miscarriages. Patient was not vaccinated for COVID. Results: NA Conclusions: This is a case of CVST without major classical predisposing factors for CVST however patient had recent COVID-19 infection which should be considered as a potential risk factor for CVST. Considering MR venogram of the head in patients presenting with persistent post-COVID headaches can help identify this potential life threating condition in a timely manner.
ABSTRACT
Objective: To determine the influence of the COVID-19 pandemic on seeking timely stroke care in Nebraska. Background: Stroke is the 5th leading cause of mortality in the United States and a major contributor to disability. Timely stroke management has made a significant impact in reducing morbidity and mortality. Reduction in hospital visits for myocardial infarctions and strokes have been reported during current and prior pandemics. Studying changing patterns of seeking stroke care can identify vulnerable populations, increase awareness and improve systems to ensure timely hospital access during the pandemic. Design/Methods: This is a retrospective chart review of patients aged 19-89 years who presented within the acute stroke (24 hour) window at our institution's emergency departments (ED) from 1/1/2020 to 4/30/2020 and 1/1/2019 to 4/30/2019. Interrupted time-series design was used to identify differences between the two time periods in terms of ED acute stroke presentation, presentation within IV thrombolysis and mechanical thrombectomy time windows, stroke admissions, types of stroke, stroke severity, demographics, stroke risk factors and baseline disability. Statistical significance was defined as P-value of ≤ 0.05. Results: 608 eligible patients were identified (mean age 64.1±14.8 years;52% were females);out of which 330 (54%) presented within the stated 2020 time period. Time from last known well (LKW) to presentation was increased during the stated pandemic period (median 8.5 [2-24] hours vs. 6 [2-16] hours;p=0.010). Stroke admissions were higher (82.1 % vs. 70.5 %;p=<0.001). Large vessel occlusion was more common in ischemic stroke patients during the pandemic (10.6% vs 4.1%;p= 0.03). Presentation within the acute stroke window decreased significantly in April 2020 compared to April 2019 (17.9% vs 21.9%;p=0.05). Conclusions: Time from last LKW to ED presentation increased and presentation within the acute stroke window eventually decreased during the pandemic, especially as the pandemic spread within Nebraska.