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Neurol Clin ; 39(2): 671-687, 2021 05.
Article in English | MEDLINE | ID: covidwho-1157630


Although minor neurologic complications of coronavirus disease 2019 are common, life-threatening neurologic emergencies are rare. Acute ischemic stroke, intracerebral hemorrhage, venous sinus thrombosis, seizures, and posterior reversible encephalopathy syndrome have been described. Hospitals have seen significant changes in the volume of patients presenting with neurologic emergencies. We review what has thus far been published about the intersection of coronavirus disease 2019 and neurologic emergencies with particular attention to cerebrovascular disease and seizure. Considerations in managing the acute presentations of these conditions in the context of the pandemic can serve as a model for management of other neurologic emergencies.

Acute Disease/therapy , COVID-19 , Cerebrovascular Disorders/therapy , Emergencies , Seizures/therapy , Humans
J Neurointerv Surg ; 14(1)2022 Jan.
Article in English | MEDLINE | ID: covidwho-1072792


BACKGROUND: Unprecedented workflow shifts during the coronavirus disease 2019 (COVID-19) pandemic have contributed to delays in acute care delivery, but whether it adversely affected endovascular thrombectomy metrics in acute large vessel occlusion (LVO) is unknown. METHODS: We performed a retrospective review of observational data from 14 comprehensive stroke centers in nine US states with acute LVO. EVT metrics were compared between March to July 2019 against March to July 2020 (primary analysis), and between state-specific pre-peak and peak COVID-19 months (secondary analysis), with multivariable adjustment. RESULTS: Of the 1364 patients included in the primary analysis (51% female, median NIHSS 14 [IQR 7-21], and 74% of whom underwent EVT), there was no difference in the primary outcome of door-to-puncture (DTP) time between the 2019 control period and the COVID-19 period (median 71 vs 67 min, P=0.10). After adjustment for variables associated with faster DTP, and clustering by site, there remained a trend toward shorter DTP during the pandemic (ßadj=-73.2, 95% CI -153.8-7.4, Pp=0.07). There was no difference in DTP times according to local COVID-19 peaks vs pre-peak months in unadjusted or adjusted multivariable regression (ßadj=-3.85, 95% CI -36.9-29.2, P=0.80). In this final multivariable model (secondary analysis), faster DTP times were significantly associated with transfer from an outside institution (ßadj=-46.44, 95% CI -62.8 to - -30.0, P<0.01) and higher NIHSS (ßadj=-2.15, 95% CI -4.2to - -0.1, P=0.05). CONCLUSIONS: In this multi-center study, there was no delay in EVT among patients treated for intracranial occlusion during the COVID-19 era compared with the pre-COVID era.

COVID-19 , Endovascular Procedures , Neurology , Stroke , Benchmarking , Female , Humans , Male , Retrospective Studies , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/surgery , Thrombectomy , Time-to-Treatment , Treatment Outcome
J Stroke Cerebrovasc Dis ; 29(8): 104980, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-343178


BACKGROUND: The COVID-19 pandemic has presented unprecedented challenges to healthcare organizations worldwide. A steadily rising number of patients requiring intensive care, a large proportion from racial and ethnic minorities, demands creative solutions to provide high-quality care while ensuring healthcare worker safety in the face of limited resources. Boston Medical Center has been particularly affected due to the underserved patient population we care for and the increased risk of ischemic stroke in patients with COVID-19 infection. METHODS: We present protocol modifications developed to manage patients with acute ischemic stroke in a safe and effective manner while prioritizing judicious use of personal protective equipment and intensive care unit resources. CONCLUSION: We feel this information will benefit other organizations facing similar obstacles in caring for the most vulnerable patient populations during this ongoing public health crisis.

Betacoronavirus/pathogenicity , Brain Ischemia/virology , Coronavirus Infections/therapy , Endovascular Procedures , Health Services Needs and Demand/organization & administration , Needs Assessment/organization & administration , Pneumonia, Viral/therapy , Radiography, Interventional , Stroke/therapy , Thrombolytic Therapy , Boston , Brain Ischemia/diagnosis , Brain Ischemia/epidemiology , COVID-19 , Clinical Decision-Making , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Critical Pathways/organization & administration , Endovascular Procedures/adverse effects , Host Microbial Interactions , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Radiography, Interventional/adverse effects , Risk Assessment , Risk Factors , SARS-CoV-2 , Stroke/diagnosis , Stroke/epidemiology , Thrombolytic Therapy/adverse effects , Treatment Outcome , Triage/organization & administration