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1.
Neurol Sci ; 2022 Mar 25.
Article in English | MEDLINE | ID: covidwho-1763365

ABSTRACT

BACKGROUND: It has been reported that acute stroke services were compromised during COVID-19 due to various pandemic-related issues. We aimed to investigate these changes by recruiting centers from different countries. METHODS: Eight countries participated in this cross-sectional, observational, retrospective study by providing data from their stroke data base. We compared 1 year before to 1 year during COVID-19 as regards onset to door (OTD), door to needle (DTN), door to groin (DTG), duration of hospital stay, National Institute of Health Stroke Scale (NIHSS) at baseline, 24 h, and at discharge as well as modified Rankin score (mRS) on discharge and at 3 months follow-up. RESULTS: During the pandemic year, there was a reduction in the number of patients, median age was significantly lower, admission NIHSS was higher, hemorrhagic stroke increased, and OTD and DTG showed no difference, while DTN time was longer, rtPA administration was decreased, thrombectomy was more frequent, and hospital stay was shorter. mRS was less favorable on discharge and at 3 months. CONCLUSION: COVID-19 showed variable effects on stroke services. Some were negatively impacted as the number of patients presenting to hospitals, DTN time, and stroke outcome, while others were marginally affected as the type of management.

2.
Egypt J Neurol Psychiatr Neurosurg ; 58(1): 8, 2022.
Article in English | MEDLINE | ID: covidwho-1637079

ABSTRACT

Background: Corona virus disease of the year 2019 (COVID-19) is still devastating the world for more than 19 months since its declaration as a pandemic by world health organization. Its manifestations does not stand at respiratory system but involves other body systems including central nervous system and its vasculature. In the following case report, cerebral venous and arterial thrombosis is detected in a case just in convalescence from COVID-19 with still detected positive IgM. Case presentation: A 68-year-old female presenting with disturbed conscious level, bilateral convergent squint, single attack of generalized seizures, left sided dense weakness within a short time from catching COVID-19 and while still in quarantine hospital in recovery phase from infection. Magnetic resonance studies revealed bilateral cortical border zone infarcts as well as left lateral dural sinus and deep venous thrombosis. Conclusion: Along the forth wave, COVID-19 is still hitting hardly the central nervous system vasculature.

3.
Neurol Sci ; 43(2): 799-809, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1520369

ABSTRACT

COVID-19 is a pandemic disease which predominantly affects the respiratory system with high critical care mortality and morbidity; however, it also causes multi-organ dysfunction in a subset of patients. Although causality between COVID-19 and mucormycosis remains unclear, many factors including glucocorticoids, worsening of blood glucose control, and viral-induced lymphopenia have been attributed to cause mucormycosis in patients with COVID-19. In COVID-19 patients, especially those who need oxygen support, inflammatory and cytokine storm or usage of steroids make the immune system weak. This may pave the way for opportunistic infections including mucormycosis. We report fourteen cases of COVID-19 infection, who developed rhino-orbito-cerebral mucormycosis, during treatment. Early recognition of this life-threatening infection is the key to allow for optimal treatment and improved outcomes.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Antifungal Agents/therapeutic use , Egypt , Humans , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Orbital Diseases/drug therapy , SARS-CoV-2 , Tertiary Care Centers
4.
Egypt J Neurol Psychiatr Neurosurg ; 57(1): 100, 2021.
Article in English | MEDLINE | ID: covidwho-1327953

ABSTRACT

BACKGROUND: Direct neurological manifestations of coronavirus disease whether peripheral or central are reported worldwide. Yet, along the 3rd wave of the pandemic especially in India, an associated angioinvasive opportunistic infection with mucormycosis in COVID-19 cases is emerging. CASE PRESENTATION: The current case series which represents 4 patients with mucormycosis post COVID-19 is one of a few if not the first case series that discusses post COVID-19 mucormycosis from a neurological prospective in a tertiary hospital in Egypt.All cases but one presented with total ophthalmoplegia, and only one was diagnosed as a cavernous sinus thrombosis; meanwhile, orbital cellulitis and orbital apex syndrome were responsible of ophthalmoplegia in two cases.Mortality reached 25%, and the case that died suffered cutaneous as well as rhino-cerebral type with a delayed presentation to hospital. CONCLUSION: A rare but fatal fungal infection is ought to be nowadays kept in mind in COVID-19 active cases as well as in recovered COVID-19 patients, especially those who have comorbid medical conditions as uncontrolled diabetes and who were treated with large doses of corticosteroids.

5.
PLoS One ; 16(7): e0254228, 2021.
Article in English | MEDLINE | ID: covidwho-1309960

ABSTRACT

BACKGROUND: In the current study we investigated the causes of pre-hospital delay as this can compromise the patient's chance to receive thrombolytic therapy and thus impact stroke outcome. METHODS: We surveyed 254 patients regarding reasons for delayed and early arrival to hospital after acute ischemic stroke. The survey was performed over five months, spanning a period pre- and during COVID-19 (between December 7, 2019 and May 10, 2020). RESULTS: A total of 71.2% of patients arrived beyond four hours of onset of ischemic stroke. The commonest cause for delay pre-Covid-19 was receiving treatment in a non-stroke hospital, while that during COVID-19 was fear of infection and lock down issues. Not realizing the urgency of the condition and stroke during sleep were common in both periods. Early arrival because of the patient's previous experience with stroke accounted for approximately 25% of cases in both periods. The effect of media was more evident during COVID-19, accounting for 47.7% of cases. CONCLUSION: Pre-hospital delay secondary to misperception of the urgency of stroke and management in a non-stroke hospital reflect the lack of awareness among the public and medical staff. This concept is emphasized by early arrival secondary to previous experience with stroke and the pronounced effect of media in the time of COVID-19.


Subject(s)
Brain Ischemia/psychology , COVID-19/psychology , Ischemic Stroke/psychology , Time-to-Treatment/statistics & numerical data , Aged , COVID-19/epidemiology , Egypt , Emergency Service, Hospital , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Time Factors
6.
Neurology ; 96(23): e2824-e2838, 2021 06 08.
Article in English | MEDLINE | ID: covidwho-1261288

ABSTRACT

OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.


Subject(s)
COVID-19 , Stroke , Cross-Sectional Studies , Hospitalization , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/drug therapy , Stroke/epidemiology , Thrombolytic Therapy
7.
Egypt J Neurol Psychiatr Neurosurg ; 57(1): 63, 2021.
Article in English | MEDLINE | ID: covidwho-1238737

ABSTRACT

Severe acute respiratory syndrome corona virus 2 hit strongly and hardly the entire globe for more than 1 year with a morbidity exceeding 139 million and a mortality approaching 3 million worldwide since its emergence in China in December 2019 until April 2021. Although being termed after its ancestor the acute respiratory syndrome corona virus that emerged in 2002. Yet, the current corona virus has its unique devastating presentations being pulmonary and extra pulmonary. In the current review, a highlight on the role played by corona virus 2 on pathogenesis and outcome of stroke is presented with an attempt to point to the most approved ways through which the corona virus induce stroke being disturbance in renin angiotensin system and angiotensin-converting enzyme 2 receptors downregulation, endothelial cell damage with coagulopathy, cytokine storm, and platelet as well as outcome and risks in patients who are suffering stroke with modifiable vascular risk factors and catching the severe acute respiratory syndrome corona virus 2.

8.
Neurology ; 96(23): e2824-e2838, 2021 06 08.
Article in English | MEDLINE | ID: covidwho-1154058

ABSTRACT

OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.


Subject(s)
COVID-19 , Stroke , Cross-Sectional Studies , Hospitalization , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/drug therapy , Stroke/epidemiology , Thrombolytic Therapy
9.
Egypt J Neurol Psychiatr Neurosurg ; 56(1): 120, 2020.
Article in English | MEDLINE | ID: covidwho-999767

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus that has been reported to have various neurological manifestations. Cerebrovascular disorders have been encountered as a coronavirus disease 2019 (COVID-19) presentation in our center during the pandemic. CASE PRESENTATION: We are presenting 10 cases with cerebrovascular manifestations after having COVID-19 few days prior to stroke. CONCLUSION: Cerebrovascular manifestations can occur in association with COVID-19 and may have significant implications on prognosis and management.

10.
SSRN; 2020.
Preprint | SSRN | ID: ppcovidwho-1794

ABSTRACT

Background: In the COVID-19 era, stroke patients might refrain from seeking medical helfor fear of COVID-19 infection. Thus acute stroke pathway ought to be r

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