ABSTRACT
Objective: To study the cause of prolonged altered sensorium following cessation of sedation in mechanically ventilated patients Background: Patients with severe COVID-19 are at risk of thrombotic complications such as deep vein thrombosis, pulmonary thromboembolism, myocardial infarction and stroke. The incidence of strokes following COVID-19 is reported to be around 1.2%. There has been an increased incidence of large vessel strokes, especially, in young patients without any known risk factors in patients with COVID-19. Design/Methods: We report four cases of stroke diagnosed following neuroimaging in patients with severe COVID-19 Acute respiratory distress syndrome (ARDS). Results: All the patients were receiving supportive treatment and mechanical ventilation at the time of diagnosis of stroke. All patients received sedation and paralytics during mechanical ventilation. Poor response to stimulation and inability to wake up after sedation had worn off prompted neuroimaging in these patients, which revealed stroke. Incidentally, all these patients had hypernatremia at the time of diagnosis of stroke. Conclusions: This case series suggests that stroke should be considered in all COVID-19 patients who continue to have altered sensorium even after the cessation of sedation.
ABSTRACT
Patients with severe COVID-19 are at risk of thrombotic complications such as deep vein thrombosis, pulmonary thromboembolism, myocardial infarction, and stroke. The incidence of strokes following COVID-19 is reported to be around 1.2%. There has been increased incidence with COVID-19 of large vessel strokes, especially in young patients without any known vascular risk factors. We reported four patients with severe COVID-19-associated acute respiratory distress syndrome where stroke was diagnosed following neuroimaging. All the patients were on ventilatory assistance and supportive treatment when stroke was diagnosed. They had received sedation and paralytics during mechanical ventilation. Poor response to stimulation and nonresponsiveness after wearing off sedation prompted neuroimaging in these patients, which revealed stroke. Incidentally, all these patients had hypernatremia when stroke was diagnosed. This case series suggests that stroke should be considered a possible cause in all COVID-19 patients presenting with abnormal or altered sensorium.
ABSTRACT
Background: Governments have imposed lockdowns in the wake of the COVID-19 pandemic. Hospitals have restricted outpatient clinics and elective services meant for non-COVID illnesses. This has led to patients facing unprecedented challenges and uncertainties. This study was carried out to assess patients' concerns and apprehensions about the effect of the lockdown on their treatments. Materials and Methods: An ambispective, observational cross-sectional single centre study was conducted. Patients were contacted telephonically and requested to answer a structured questionnaire. Their responses were documented and summarized as frequency and proportions. Results: A total of 727 patients were interviewed. Epilepsy (32%) was the most common neurological illness in our cohort followed by stroke (18%). About half the patients and/or their caregivers reported health-related concerns during the lockdown. The primary concern was how to connect with their treating neurologist if need arose. Forty-seven patients (6.4%) had drug default. Among patients on immunomodulatory treatments, only eight patients had drug default. High compliance rates were also observed in the stroke and epilepsy cohorts. Of the 71 patients who required emergency care during the lockdown, 24 could reach our hospital emergency. Fourteen patients either had a delay or could not seek emergency care. Two-thirds of our patients found the telemedicine experience satisfactory. Conclusion: The ongoing pandemic will continue to pose challenges to both physicians and patients. Patients in follow-up may need to be contacted regularly and counselled regarding the importance of maintaining drug compliance. Telemedicine can be used to strengthen the healthcare delivery to patients with non-COVID illnesses.