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European Journal of Neurology ; 29:72, 2022.
Article in English | EMBASE | ID: covidwho-1978446


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.

Milano University Press. Chapter ; 16:02, 2021.
Article in English | MEDLINE | ID: covidwho-1836687
European Journal of Neurology ; 28(SUPPL 1):159, 2021.
Article in English | EMBASE | ID: covidwho-1307714


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.

Eur J Neurol ; 27(12): 2641-2645, 2020 12.
Article in English | MEDLINE | ID: covidwho-877180


BACKGROUND AND PURPOSE: Comorbidity of acute ischaemic stroke with Covid-19 is a challenging condition, potentially influencing the decision of whether to administer intravenous thrombolysis (IVT). We aimed to assess the 1-month outcome in ischaemic stroke patients with Covid-19 infection who received IVT alone or before thrombectomy (bridging therapy). METHODS: As a collaboration initiative promoted by the Italian Stroke Organization, all Italian stroke units (n = 190) were contacted and invited to participate in data collection on stroke patients with Covid-19 who received IVT. RESULTS: Seventy-five invited centers agreed to participate. Thirty patients received IVT alone and 17 received bridging therapy between 21 February 2020 and 30 April 2020 in 20 centers (n = 18, Northern Italy; n = 2, Central Italy). At 1 month, 14 (30.4%) patients died and 20 (62.5%) survivors had a modified Rankin Scale (mRS) score of 3 to 5. At 24 to 36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in eight (17.4%) patients and symptomatic ICH (sICH) in two (4.3%) patients. Causes of death were severe ischaemic stroke (n = 8), a new ischaemic stroke (n = 2), acute respiratory failure (n = 1), acute renal failure (n = 1), acute myocardial infarction (n = 1), and endocarditis (n = 1). In survivors with a 1-month mRS score of 3 to 5, baseline glucose level was higher, whereas endovascular procedure time in cases of bridging therapy was longer. Baseline National Institutes of Health Stroke Scale glucose and creatinine levels were higher in patients who died. CONCLUSIONS: Intravenous thrombolysis for patients with stroke and Covid-19 was not a rare event in the most affected areas by pandemic, and rates of 1-month unfavorable outcomes were high compared to previous data from the pre-Covid-19 literature. However, risk of sICH was not increased.

COVID-19/complications , COVID-19/therapy , Ischemic Stroke/complications , Ischemic Stroke/therapy , Thrombolytic Therapy/methods , Aged , Aged, 80 and over , Blood Glucose/analysis , COVID-19/mortality , Cause of Death , Creatinine/blood , Female , Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/therapeutic use , Humans , Injections, Intravenous , Ischemic Stroke/mortality , Italy/epidemiology , Male , Pandemics , Survival Analysis , Thrombectomy , Treatment Outcome