ABSTRACT
Objective: see below Background: Reports suggest that acute stroke triage and treatment may have been delayed during the beginning of COVID due to patient reluctance for hospital presentation. Furthermore, we hypothesize that stroke patients with mild symptoms NIHSS<=5, rather than disabling NIHSS>5, are more likely to present in a delayed fashion during the pandemic, compared to before. Design/Methods: We used Get with The Guidelines Stroke registry to identify stroke patients that presented between Jan1 and Aug31, 2020 to the University Hospital in San Antonio, Texas. The cohort was stratified by date of presentation(before COVID: Jan 1-Mar15 and during COVID: Mar16-Aug31)and presenting NIHSS(<=5vs>5). We then analyzed by the thrombolytic exclusion criteria “delay to arrival” and time interval of stroke symptoms discovery to hospital presentation. These outcomes were further stratified by age, sex, and ethnicity;race was excluded due to 90%Caucasian cohort. Results: A total of 294 subjects were included of which 115 were before and 179 were during COVID. There were no significant differences in the demographics for before and during, although a trend for greater male presentation was seen during COVID (Table1)When comparing before and during COVID, the time interval of stroke symptoms discovery to hospital arrival(Table2)and thrombolytic exclusion criteria “delay to arrival”(Table3)were not significantly different across all subgroups dichotomized by NIHSS<=5 Conclusions: Despite dichotomizing our cohort by low NIHSS, we did not demonstrate a significant time delay in acute stroke presentation to our hospital when comparing before and during COVID. Although our study included a large Hispanic population, the cohort was primarily Caucasian;and therefore, the results have limited application to other races. Whether men were more likely than women to present with stroke during COVID is unclear but warrants further study with a larger sample size. (Table Presented).
ABSTRACT
Objective: The nervous system is not spared by COVID19 and can get involved during the disease course regardless of the respiratory status. We studied the neurological manifestations of COVID19 in patients who were diagnosed at the Audie L Murphy Veteran's Affair (VA) hospital in San Antonio, Texas. Background: Increasing reports of COVID19 related neurological complications such as headache, anosmia, neuropathy, stroke, and seizure are being released every day. Although the exact pathophysiology of Coronavirus transmission to the nervous system is still unknown, research shows that the virus invades the nerve endings anterograde or retrogradely. The largest retrospective study was done in Wuhan, China in which 36.4% of their 214 patients with COVID 19 had neurological complications. In this research, we reviewed the prevalence of neurological symptoms amongst the veteran's population. Design/Methods: Veterans with confirmed COVID19 polymerase chain reaction (PCR) are enrolled in the Neurology Convalescence Program at least 30 days after the resolution of the acute infection. Patients are contacted over the phone and a detailed neurological review of system is performed. Available medical records, laboratory results, and imaging are reviewed. Results: A total of 41 patients are included in this preliminary analysis. Their mean age is 53.73 and 78% are men (n:32). The most common neurological disorders are headache (n:20, 48.7%) followed by anosmia (n:17, 41.4%), memory or concentration issues (n:14, 34.1%), dysgeusia (n:13, 31.7%), dizziness (n:8, 19.5%) and sensory changes (n:6, 14.6%). Conclusions: COVID19 neurological complications are still being explored longterm recovery is unknown. Our study suggests that some neurological conditions such as headache can occur at a higher rate amongst veterans. Additional data of this ongoing study will be available at the time of the AAN meeting.