ABSTRACT
Background and Aims: The benefits of stroke management is timesensitive. However, healthcare service disruptions and fears related to the COVID-19 pandemic have resulted in reduced stroke admissions. We aim to compare variables associated with early versus late time-toadmissions following acute stroke and transient ischemic attack (TIA) during the pandemic. Method(s): We conducted a prospective cross-sectional study in a 5-month period. Data was collected via questionnaire and guided interview. Descriptive and bivariate chi-square analyses was conducted comparing variables between early and late admission (cut-off 4.5 hours). Result(s): 137 patients were included. Most were male (59.1%) with a mean age of 61.12 (SD +/-13.52). Diagnoses were ischemic stroke (83.2%), hemorrhagic stroke (9.5%), and TIA (7.3%). Median time-to-admission was 7 hours (IQR 2.00-23.00). 60.6% of patients experienced delayed time-to-admission exceeding 4.5 hours. Factors associated with early arrival include a diagnosis of hemorrhagic stroke (p<0.001), symptoms of altered mentation (p<0.001) and visual dysfunction (p=0.001), routine anti-hypertensive usage (p=0.015), higher education level (p=0.004), perceptions of seriousness (p<0.001) and urgency (p<0.001), and recognition of stroke (p<0.001). Being alone during onset of symptoms was significantly associated with delayed arrival (p<0.001). Conclusion(s): A majority of stroke patients were admitted after the golden period, due to failure in recognizing symptoms of stroke and low perceptions of seriousness and urgency. Other factors such as perceived severity of symptoms (i.e., altered mental status, visual dysfunction), a higher education, and routine use of hypertensives, contributes to early arrival. This study can be used to inform future public health intitiatives and campaigns.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to be a global issue. While immunizations comprise an important line of defense, adverse effects may occur. We report two cases of autoimmune conditions affecting the nervous system, anti-N-Methyl-D-Aspartate-receptor (NMDAR) encephalitis and myasthenia gravis (MG), that developed in close association with COVID-19 vaccination. CASE REPORT: In our first case, a 29-year-old woman presents with recurrent seizures, auditory hallucinations, psychiatric symptoms, and autonomic abnormalities, with an onset of 1 day after receiving the second dose of inactivated SARS-CoV-2 whole virus vaccine. CSF analysis and electroencephalogram (EEG) were consistent with anti-NMDAR encephalitis. In our second case, a 23-year-old woman presents with ocular ptosis, diplopia, hoarseness, and fatigability, which first appeared 1-day after her first dose of inactivated SARS-CoV-2 whole virus vaccine. Electromyography (EMG) results established a definite diagnosis of MG. CONCLUSION(S): To the best of our knowledge, this is the first report of anti-NMDAR encephalitis and MG associated with inactivated SARS-CoV-2 whole virus vaccine. In both cases, COVID-19 vaccination appears to be the only remarkable feature of history. The authors postulate that COVID-19 vaccination may trigger underlying defects or induce failure of positive and negative selection, which may lead to autoreactivity and subsequent autoimmunity. However, further studies are required to confirm this possibility. Copyright © 2022, Scientific Foundation SPIROSKI. All rights reserved.