[Ethiopathogenetic features and course of ischemic stroke associated with COVID-19]. / Etiopatogeneticheskie osobennosti i techenie ishemicheskogo insul'ta, assotsiirovannogo s COVID-19.

OBJECTIVE: To analyze etiopathogenetic factors and course of ischemic stroke associated with new coronavirus infection (COVID-19). MATERIAL AND METHODS: A retrospective clinical study of 173 patients with ischemic stroke and COVID-19 (main group) and 86 patients with ischemic stroke without COVID-19 (comparison group) was carried out. There were no statistically significant differences in age and gender. All patients underwent standard clinical-instrumental, laboratory and neuroimaging assessments. RESULTS: Compared with the comparison group, patients with COVID-19 were less likely to have cardiovascular risk factors, the difference being statistically significant. Stroke in the main group was more severe than in the comparison group. According to the TOAST classification, an unknown stroke subtype significantly predominated in the main group. Laboratory data in the main group indicated the significance of an increase in renal-hepatic markers (creatinine, aspartate aminotransferase) and systemic inflammatory response syndrome (C-reactive protein). CONCLUSION: The development of cardiovascular diseases in patients with COVID-19 is an important negative prognostic factor that requires further study to determine the optimal management strategy.

Etiopathogenetic factors and the course of hemorrhagic stroke associated with COVID-19

Background. Acute stroke is a highly specific neurological symptom in the acute phase of COVID-19. Hemorrhagic stroke (HS) is an infrequent, but life-threatening complication of COVID-19. Objective. To analyze etiopathogenetic factors and the course of HS associated with COVID-19. Design and methods. A retrospective analysis of 27 medical histories of patients with HS associated with COVID-19 (the main group) and 14 medical histories of patients with HS not related to COVID-19 (the control group) was performed. In the main group, COVID-19 was confirmed by the positive polymerase chain reaction method. HS developed before COVID-19 symptoms in 10 (37,04 %) patients and after 4-16 days of COVID-19 symptoms onset in 17 (62,96 %) patients. Results. Our study indicates significant differences in blood pressure (BP), respiratory system parameters, laboratory data, neuroimaging data in patients of the main and control groups. Coagulopathy, thrombocytopenia, hypoxia, and the renal and hepatic failure play a significant role in the development of HS associated with COVID-19 compared to the classic HS (without COVID-19), where hypertension seems to be the important. At the same time BP is significantly lower in the main group. Conclusions. The etiopathogenetic factors and the course of HS associated with COVID-19 require pathogenetically different therapy compared to HS without COVID-19. Copyright © 2021 All-Russian Public Organization Antihypertensive League. All rights reserved.

[Predictors of unfavorable outcomes of ischemic stroke associated with COVID-19]. / Prediktory neblagopriyatnogo iskhoda ishemicheskogo insul'ta, assotsiirovannogo s COVID-19.

OBJECTIVE: To study predictors of unfavorable outcomes in ischemic stroke associated with COVID-19. MATERIAL AND METHODS: A retrospective analysis of 173 case histories of patients with ischemic stroke and COVID-19 was carried out. The average age was 68.64±11.39 (95% CI 66.93-70.35; median 92, mean 34) years. By gender, women predominated (64.16%). Fatal outcome was observed in 62 (35.84%) patients. Risk factors were studied using binary logistic regression. RESULTS: The risk of a fatal stroke in a univariate analysis was established in the presence of a general severe condition of the patient and a number of other factors, which included the severity of COVID-19, acute coronary syndrome, multiple organ failure, the need for a ventilator, a history of kidney disease, pneumonia, high NIHSS score, oxygen partial pressure level, respiratory rate, number of hospitalizations, complete blood count (erythrocytes, hemoglobin, hematocrit, leukocytes, neutrophils), coagulogram, glucose, liver and kidney markers (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, urea), levels of creatine phosphokinase, lactate dehydrogenase and C-reactive protein. A model based on multivariate analysis was used, which makes it possible to predict the probability of a fatal outcome. A regression function was obtained, which included the content of C-reactive protein, urea and NIHSS score. In patients with a value of 35% and above, there was an increased risk of death, in the case of a value below 35%, a favorable outcome was assumed. The model was statistically significant (p<0.001). The sensitivity and specificity of the model were 88.9% and 97.9%, respectively. CONCLUSION: The revealed predictors of the probability of a fatal stroke outcome can be guidelines for a Coctor in choosing a patient management strategy at different stages of patient care.

Neurological and mental disorders associated with COVID-19 [Russian]

The article presents a narrative review, clinical observations. Special attention is given to the pathogenesis, features of neurological manifestations and mental disorders, neurological complications in coronavirus infection, illustrated by clinical cases. Neurological disorders occur in approximately 36,4% patients with COVID-19. Currently, severe viral hemorrhagic encephalitis, toxic encephalopathy, acute demyelinating lesions of the peripheral nervous system, stroke, behavioral and emotional disorders have been described. Despite numerous publications on the neurological pathology in COVID-19, pathogenesis, risk factors, and relation between neurological disorders and coronavirus infection remain unclear. There is a need for systematization of the accumulated data on the damage to the nervous system during the COVID-19 epidemic for clinical routine use, further development of the optimal treatment strategy and implementation of effective preventive measures. Copyright © 2020 All-Russian Public Organization Antihypertensive League. All rights reserved.