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Neurology ; 2022 Nov 09.
Article in English | MEDLINE | ID: covidwho-2243164


BACKGROUND AND OBJECTIVES: COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19. METHODS: Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [OR] 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour (OR 2.47; 95% CI 1.58-3.86) and 3-month mortality (OR 1.88; 95% CI 1.52-2.33).COVID-19 patients also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring and establishing prognosis.

Eur J Neurol ; 28(10): 3360-3368, 2021 10.
Article in English | MEDLINE | ID: covidwho-1606972


BACKGROUND AND PURPOSE: COVID-19-related acute neurological phenotypes are being increasingly recognised, with neurological complications reported in more than 30% of hospitalised patients. However, multicentric studies providing a population-based perspective are lacking. METHODS: We conducted a retrospective multicentric study at five hospitals in Northern Portugal, representing 45.1% of all hospitalised patients in this region, between 1 March and 30 June 2020. RESULTS: Among 1261 hospitalised COVID-19 patients, 457 (36.2%) presented neurological manifestations, corresponding to a rate of 357 per 1000 in the North Region. Patients with neurologic manifestations were younger (68.0 vs. 71.2 years, p = 0.002), and the most frequent neurological symptoms were headache (13.4%), delirium (10.1%), and impairment of consciousness (9.7%). Acute well-defined central nervous system (CNS) involvement was found in 19.1% of patients, corresponding to a rate of 217 per 1000 hospitalised patients in the whole region. Assuming that all patients with severe neurological events were hospitalised, we extrapolated our results to all COVID-19 patients in the region, estimating that 116 will have a severe neurological event, corresponding to a rate of nine per 1000 (95% CI = 7-11). Overall case fatality in patients presenting neurological manifestations was 19.8%, increasing to 32.6% among those with acute well-defined CNS involvement. CONCLUSIONS: We characterised the population of hospitalised COVID-19 patients in Northern Portugal and found that neurological symptoms are common and associated with a high degree of disability at discharge. CNS involvement with criteria for in-hospital admission was observed in a significant proportion of patients. This knowledge provides the tools for adequate health planning and for improving COVID-19 multidisciplinary patient care.

COVID-19 , Nervous System Diseases , Humans , Nervous System Diseases/epidemiology , Portugal/epidemiology , Retrospective Studies , SARS-CoV-2
Stroke ; 52(5): e117-e130, 2021 05.
Article in English | MEDLINE | ID: covidwho-1195876
Acta Neurol Scand ; 144(2): 221-225, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1175024


BACKGROUND: The COVID-19 pandemic forced the implementation of social distancing and circulation restrictions. This affected all aspects of society including health care. In the field of chronic neurological disorders such as Parkinson's disease (PD), teleneurology is employed in scenarios where face-to-face interactions are not possible. A growing number of clinicians and institutions are turning to teleneurology in order to providing medical care. AIMS OF THE ARTICLE: In this manuscript, we present a practical, 'how we do it in real life', example of a teleneurology appointment with a person with PD (PwP). METHODS: We elaborated a step-by-step approach of the main aspects of a consultation with a PwP and provide video illustration. RESULTS: The key aspects of a teleneurology appointment were separated into: (1) In the office, before the appointment; (2) History taking; (3) Examination; and (4) Finishing up. CONCLUSIONS: We discuss the strengths and weaknesses of this approach and provide our experience in overcoming commonly encountered difficulties.

COVID-19 , Neurology , Parkinson Disease , Telemedicine , Videoconferencing , COVID-19/prevention & control , Humans , Practice Guidelines as Topic