Extending stroke CT angiography to the full chest allows for detection of additional pulmonary opacifications in acute stroke patients.

BACKGROUND AND PURPOSE: During epidemics with an increased prevalence of pulmonary infections, extending stroke CTA examinations of acute stroke workup to the whole chest may allow for the identification of pulmonary findings that would have been missed on standard CTA examinations. MATERIALS AND METHODS: Our analysis comprised 216 patients with suspicion of stroke who received extended full-chest cerebrovascular CTA examinations from January 27th 2020 - date of the first confirmed Covid-19 case in Germany - until April 30th 2020. RESULTS: Consolidations and ground-glass opacifications were found in 73 of all 216 patients (34%). Opacifications were found in the upper chest in 51/216 patients (23%). There were lower-chest opacifications in 22 of 165 patients (13%) with unsuspicious upper-chest scans. In these 22 patients, there were consolidations in 10 cases (45%), ground-glass opacifications in 10 cases (45%), and both in 2 cases (10%). CONCLUSIONS: Our study showed that extending the scan volume of an emergency stroke CTA to the whole chest reveals a considerable number of opacifications that would have been missed on a standard CTA. Even though these findings were rarely indicative of COVID-19, a large number of opacifications warranted further investigation.

Seeing faces, when faces can't be seen: Wearing portrait photos has a positive effect on how patients perceive medical staff when face masks have to be worn.

INTRODUCTION: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, wearing surgical face masks has become mandatory for healthcare staff in many countries when interacting with patients. Recently, it has been shown that wearing face masks impairs social interaction by diminishing a person's ability to read the emotion of their counterparts, an essential prerequisite to respond adequately in social situations. It is easily conceivable that this may have a tangible negative influence on the communication and relationship between patients and healthcare personnel. We therefore investigated whether it has an effect on how patients perceive healthcare professionals when physicians and nursing staff wear portrait photos with their smiling faces in addition to face masks. METHODS: During the study period of 16 days, the medical staff of our Department wore surgical face masks at all times during any kind of interaction with patients. In a pseudorandomized order, all members of our staff additionally affixed their portrait photos to their work clothes on 8 of the 16 days. After completion of their visit, 226 patients were interviewed anonymously in a cross-sectional study design using a questionnaire in which they rated the following three items: friendliness of staff, medical quality of treatment, and how well they felt taken care of during treatment in our Department. RESULTS: On days, on which staff wore photos, mean scores of the questionnaires were significantly higher than on non-photo days (p = 0.013; mean ± standard deviation = 92.8 ± 11.3 vs. 91.0 ± 12.6; median (range) = 97 (98) vs. 96 (76)). When analyzed separately, the increased scores were only significant for the item friendliness of staff (p = 0.009; mean ± standard deviation = 95.8 ± 6.3 vs. 92.2 ± 11.5; median (range) = 98 (39) vs. 97 (54)). CONCLUSION: Our study suggests that the use of portrait photos with smiling faces has a positive effect on how patients perceive healthcare staff.

Neurological symptoms in COVID-19: a cross-sectional monocentric study of hospitalized patients.

BACKGROUND: The SARS-Coronavirus-2 (SARS-CoV-2) invades the respiratory system, causing acute and sometimes severe pulmonary symptoms, but turned out to also act multisystematically with substantial impact on the brain. A growing number of studies suggests a diverse spectrum of neurological manifestations. To investigate the spectrum of symptoms, we here describe the neurological manifestations and complications of patients with proven SARS-CoV-2 infection who have been hospitalized at the RWTH University Hospital Aachen, Germany. METHODS: Between March and September 2020, we evaluated common symptoms, clinical characteristics, laboratory (including cerebrospinal fluid (CSF) analysis), radiological, and electroencephalography (EEG) data from 53 patients admitted with a positive SARS-CoV-2 polymerase chain reaction (PCR). We used the Montreal Cognitive Assessment Test (MoCA) to screen for cognitive impairment, when feasible. We compared critically ill and non-critically ill patients categorized according to the presence of Acute Respiratory Distress Syndrome (ARDS). RESULTS: Major clinical neurological features of hospitalized COVID-19 patients were coordination deficits (74%), cognitive impairment (61.5%), paresis (47%), abnormal reflex status (45%), sensory abnormalities (45%), general muscle weakness and pain (32%), hyposmia (26%), and headache (21%). Patients with ARDS were more severely affected than non-ADRS patients. 29.6% of patients with ARDS presented with subarachnoid bleedings, and 11.1% showed ischemic stroke associated with SARS-CoV-2 infection. Cognitive deficits mainly affected executive functions, attention, language, and delayed memory recall. We obtained cerebrospinal fluid (CSF) by lumbar puncture in nine of the 53 patients, none of which had a positive SARS-CoV-2 PCR. CONCLUSIONS: In line with previous findings, our results provide evidence for a range of SARS-CoV-2-associated neurological manifestations. 26% of patients reported hyposmia, emphasizing the neuro-invasive potential of SARS-CoV-2, which can enter the olfactory bulb. It can therefore be speculated that neurological manifestations may be caused by direct invasion of the virus in the CNS; however, PCR did not reveal positive intrathecal SARS-CoV-2. Therefore, we hypothesize it is more likely that the para-infectious severe pro-inflammatory impact of COVID-19 is responsible for the neurological deficits including cognitive impairment. Future studies with comprehensive longitudinal assessment of neurological deficits are required to determine potential long-term complications of COVID-19.

[Acute Neurointerventions, Covid-19 and Chest-CT: SOP and Literature Review]. / Notfällige Neurointerventionen, Covid-19 und Thorax-CT: SOP und Literaturübersicht.

BACKGROUND AND PURPOSE: To analyze standard operating procedures (SOP) of acute stroke imaging and interventions during COVID-19 pandemic with special emphasis on chest CT within a multimodal stroke protocol. METHODS: A questionnaire was distributed via email to members of the Professional Organization of German Neuroradiologists (Berufsverband Deutscher Neuroradiologen e.V.). RESULTS: Answers were received from 25 units: eleven of them acquire chest CT, three in any patient and eight, when COVID-19 is suspected due to body temperature increase, patient's history or when the latter cannot be sufficiently obtained. Preliminary data indicate a high sensitivity and moderate negative predictive value. CONCLUSION: Different SOP reflect an uncertainty whether chest CT should be acquired as part of a multimodal stroke protocol. Accuracy of low dose chest CT cannot be determined yet. The strengths and limitations of chest CT are discussed.