ABSTRACT
Background and aims: Quality care for medical emergencies has been affected by SARS-CoV-2 pandemic globally. Factors include increasing emergency admissions, public reluctance to seek medical help, and government-imposed public health measures. We aim to investigate the impact of the pandemic on our local acute stroke service. Methods: We conducted a retrospective analysis in a Scottish tertiary neurology referral centre, comparing acute stroke service over three-month periods: pre-pandemic (04/2019-06/2019), first lockdown (04/2020-06/2020), and second lockdown (01/2021-03/2021). We compared rates of acute stroke admissions, delayed presentations (beyond 24 hours after symptoms onset), tPA rates, door-to-needle times (DTN), SARS-CoV-2-related strokes, and non-SARS-CoV-2-related strokes. Results: Acute stroke admissions reduced significantly over the two lockdown periods compared with pre-pandemic (364 vs 398 vs 454, p<0.0001). 53/316 (16.8%) ischaemic strokes received tPA pre-pandemic, dropping to 21/245 (8.6%) during the first lockdown, and 33/231(14.3%) in the second [p=0.0111], without significant difference in DTNs. 160/527 (30.4%) strokes had delayed presentation in lockdowns, compared with 66/352 (18.8%) pre-pandemic [p<0.0001]. In the 6-month pandemic periods, 13/531 strokes (2.4%;11 ischaemic, 2 TIAs) were related to SARS-CoV-2-infection. Age and sex were similar compared with non-SARS-CoV-2-related strokes;however, the former had a much higher baseline NIHSS (12 vs 4, p<0.05), with 2 receiving tPA. Conclusions: As in previous studies, significant reductions in acute stroke admissions during the pandemic were noted in our centre. More patients presented delayed, thus missing the thrombolysis window. Only a small proportion of strokes were thought to be related to SARS-CoV- 2-infection in our centre, but with severer symptoms.