ABSTRACT
Background and aims: The Coronavirus Disease Pandemic - 2019 (COVID-19) represents, to date, the greatest public health challenge of the 21st century. Stroke, on the other hand, is nationally the main cause of disability, accompanied by a considerable and costly number of hospitalizations. This paper questions the impact of COVID-19 on stroke notifications. Methods: Articles were searched using the descriptors: Ischemic Stroke;Hemorrhagic Stroke;Cerebrovascular events;COVID-19 and Brazil. The research platforms were Pubmed, Scielo, Virtual Health Library and DataSUS. Results: Since the beginning of the pandemic in Brazil, in March 2020, there has been a reduction of approximately 20% in the number of stroke cases reported compared to 2019. This reality is consistent with the international scenario of possible underreporting and reduced demand for medical care in mild and intermediate cases. Although, according to medical societies of national specialties, COVID-19 does not change the recommendations for the management of patients with stroke, the result of this context may be a late start of care, loss of the therapeutic window and worsening of stroke outcomes in the country. The attention to safety protocols and the importance of telemedicine for pre-hospital care was also highlighted. Conclusion: Given the decrease in the number of cases of stroke, there is an alert regarding underreporting and delay in care, problems already present in the national scenario that may be potentiated by the pandemic, where the concern with COVID-19 overlaps with other diseases, which may increase the damage (in the short and long term) to public health.
ABSTRACT
Background and aims: Although it primarily damages the respiratory system, COVID-19 can also develops with neurological conditions such as stroke. This study aims to describe a case report of a patient with ischemic stroke related to COVID-19. Methods: Male, 44 years old, with untreated diabetes, admitted to emergency with left hemiplegia and dysarthria. Patient had flu-like symptoms 11 days ago and was diagnosed with COVID-19. Auscultation revealed bilateral bases rhonchi. Normotensive, oxygen saturation: 94%, glycemia: 241mg/dl, increased lactate and CRP;hemogram, D-Dimer and coagulogram unchanged. Brain CT demonstrated no evidence of hemorrhagic injury. Chest CT revealed bilateral lung involvement with ground-glass opacities. The patient remained hospitalized for 21 days and was discharged still with motor deficits. Results: The literature suggests that the mechanisms of ischemic stroke associated with COVID-19 are multiple, highlighting the cytokine storm and coagulation dysfunction. Increased lactate and CRP suggest an acute inflammatory activity;however, the patient did not exhibit high levels of D-dimer, platelet or coagulogram changes. Strokes associated with COVID-19 occur mainly in elderly patients and critically sick. Patients with mild clinical presentation of the disease have an incidence of strokes less than 1%. Although the patient does not have the risk factors mentioned above, diabetes may represent a predisposing factor of the neurological complication. Conclusion: Patients with mild respiratory conditions may present severe neurological complications, possibly due to the association between previous comorbidity and coagulopathy from COVID-19. The strokes associated with COVID-19 may present greater mortality and disability when compared to cases unrelated to COVID-19.