ABSTRACT
COVID-19 patients have presented with a wide range of neurological disorders, among which stroke is the most devastating. We have reviewed current studies, case series, and case reports with a focus on COVID-19 patients complicated with stroke, and presented the current understanding of stroke in this patient population. As evidenced by increased D-dimer, fibrinogen, factor VIII and von Willebrand factor, SARS-CoV-2 infection induces coagulopathy, disrupts endothelial function, and promotes hypercoagulative state. Collectively, it predisposes patients to cerebrovascular events. Additionally, due to the unprecedented strain on the healthcare system, stroke care has been inevitably compromised. The underlying mechanism between COVID-19 and stroke warrants further study, so does the development of an effective therapeutic or preventive intervention.
ABSTRACT
OBJECTIVE: As COVID-19 spreads around the world, so does telemedicine across many medical specialties including neurosurgery. Given the unique patient population in neurosurgery, arising opportunities for integration and expansion of telemedicine into neurosurgery practice come with challenges for both the patient and the provider. METHODS: A literature review has been performed, and a survey has been sent out to neurosurgery providers in Texas to determine if providers are satisfied with the current state of telemedicine in their clinical practice. RESULTS: Patients who live far away from a medical center have cited increased convenience when routine postoperative visits have been converted to telemedicine. For providers, challenges have arisen in performing physical exams, especially when performing detailed neurological exams in the diagnosis of a spine disorder. Survey results of neurosurgery providers have revealed mixed opinions since the initiation of telemedicine. CONCLUSION: Although it is unclear what role telemedicine will have after the social distancing restrictions are lifted, many providers surveyed have expressed interest in keeping telemedicine in their clinical practice.
ABSTRACT
OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.