Does gender influences outcome of stroke in COVID+ and COVID- patients: a large collaborative study in Northern Italy

Background and aims: The impact of the COVID-19 pandemic during the first wave in Italy caused a decrease of hospital admissions, delays in reperfusion treatments and an overall worse outcome in COVID+ patients with stroke. However, few data are available on outcome of stroke stratified by gender. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted in 19 Neurology Units by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to Neurological units between March-April 2020 with ischaemic stroke were recruited. Demographic, clinical, treatment and outcome data were compared in patients with (COVID19+) and without COVID-19 (COVID19-), as well as in male and female patients. Results: 812 patients with ischemic stroke were enrolled (682 COVID-, 129 COVID+);males were 54.1% and 52.7%. Intra-hospital mortality was 31.9% in COVID+ patients (38.6% in male and 27.8% in female) and 7.2% in COVID- (8.4% in males and 6% in females). Male patients with COVID+ were more likely to have cPAP (30.9% vs 14.8%;p=0.03) or being intubated (14.9% vs 3.3%;p=0.02) than females. Reperfusion treatment was administered more frequently in women if COVID- (34.5% vs 29.8%), while less frequently if COVID+ (11.5% vs 29.4%;p=0.01). COVID+ patients had a higher frequency of ESUS than COVID- (31.8% vs 22.3%;p=0.02), with a higher frequency in COVID+ females compared to males (36.1% vs 27.9%). Conclusion: Our study detected some differences due to gender in ischaemic stroke with and without COVID-19. Multivariate analyses is ongoing to define predictors of mortality across gender categories.

Clinical, neurophysiological and neuroradiological characteristics of 30 cases of SARS-COV-2-associated encephalitis in Lombardia

Background and aims: The number of cases of encephalitis in COVID-19 pandemic is increasing. We describe characteristics and outcome of encephalitis in COVID-19 (COV-ENC) patients in one of the most affected regions by COVID-19 of the world, Lombardia, during the first pandemic wave. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to 20 Neurological Departments in Lombardia between February-April 2020 with COV-ENC have been included. Results: 30 COV-ENC patients had a mean age of 66.5 years and male frequency of 56.6%. Altered consciousness was characterized by confusion in 86%, coma in 30%, delirium in 37.9% and alteration of personality traits in 27.6%. Epileptic seizures occurred in 74% of cases. One third of cases had hyperproteinorrachia, one third pleocytosis/hyperproteinorrachia, and remaining third had a normal CSF. PCR for SARS-CoV-2 was negative in all tested patients. EEG was altered in 82.7% of patients. Brain CT and MRI were normal in 9 patients, and among abnormal findings 9 patients had mesial temporal lesions, one of which confirmed with PET imaging. The course was favorable in 39.2% of patients, sequelae were few in 26.6% and moderate in 19.2%, while 20% of patients died. Conclusions: The outcome tends to be worse in male patients. PCR negativity seems to confirm an autoimmune etiology more than a direct invasion of the virus. However, a temporal lobe involvement, detected in 30% of patients with COV-ENC, suggests usual sites of encephalitis due to herpes virus.

Primary intracerebral haemorrhage during SARS-CoV-2 outbreak

Background and aims: Mounting data has been published as to the impact of SARS-CoV-2 on cerebrovascular events, particularly on ischemic strokes. Our study addresses the clinical course of patients with cerebral haemorrhage and simultaneous SARS-CoV-2 infection, paying particular attention to both SARS-CoV-2 positive and negative patients hospitalized during the pandemic. Methods: The Italian Society of Hospital Neurosciences (SNO) promoted a multicentre, retrospective, observational study (SNO-COVID-19), involving 20 Neurology Units in Northern Italy. Data were collected on patients consecutively admitted to neurological departments, from March 1st to April 30th with cerebrovascular diseases, occurring either at home or during hospitalization for other causes. Results: 949 patients were enrolled (average age 73.4 years;52.7% males);135 patients had haemorrhagic stroke and 127 (13.4%) had a primary ICH. Only 16 patients with ICH (12.6%) had laboratory confirmed SARS-CoV-2 infection, clinically expressed or not. SARS-CoV-2 related pneumonia or respiratory distress, lobar location and previous antiplatelet or anticoagulant treatment were the only factors significantly associated with increased mortality in ICH. SARS-CoV-2 infection, regardless of respiratory involvement, led to a nonsignificantly increased risk of in-hospital death. Conclusion: Our study confirms that age, ICH location and previous antiplatelet or anticoagulant treatment are predictors of in-hospital death. Unlike ischemic stroke, ICH in SARS-CoV-2 patients led only to a slight increase in mortality, mainly due to respiratory involvement.

COVID-19 and Guillain-Barré syndrome in early pandemia in Lombardia: Increased incidence or increased seroprevalence?

Background and aims: Several studies reported increased incidence of Guillain-Barre' Syndrome (GBS) after Zika epidemic, SARS-CoV and MERS, and more recently SARS-CoV-2 infection. We estimate incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients in one of the most affected regions by COVID-19 of the world, Lombardia. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted in 20 Neurology Units by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to Neurological units between February-April 2020 with COVID19-GBS were included. Results: 38 COVID19-GBS patients had mean age of 60.7 years and male frequency of 86.8%. Mean interval between COVID-19 onset and GBS onset was 15.1 days. CSF albuminocytologic dissociation was detected in 71.4% of cases, PCR for SARS-CoV-2 negative in all 15 tested patients, and anti-ganglioside antibodies positive in 43.7%. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP diagnosis, 12.1% AMSAN and 6% AMAN. 29 patients have been treated with intravenous Immunoglobulin (IVIg), two with plasma exchange (PE), two with PE followed by IVIg and five untreated. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.1% worsened, of which three died. The estimated occurrence rate in Lombardia is 0.5 GBS cases per 1000 COVID-19 infections. Conclusion: We detected an increased incidence of GBS in COVID-19 patients which can reflect higher risk of GBS in COVID-19 patients or be secondary to an increase of prevalence of prior infection in that period.