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1.
Journal of Stroke Medicine ; : 25166085221085780, 2022.
Article in English | Sage | ID: covidwho-1794036

ABSTRACT

Patients with severe COVID-19 are at risk of thrombotic complications such as deep vein thrombosis, pulmonary thromboembolism, myocardial infarction, and stroke. The incidence of strokes following COVID-19 is reported to be around 1.2%. There has been increased incidence with COVID-19 of large vessel strokes, especially in young patients without any known vascular risk factors. We reported four patients with severe COVID-19-associated acute respiratory distress syndrome where stroke was diagnosed following neuroimaging. All the patients were on ventilatory assistance and supportive treatment when stroke was diagnosed. They had received sedation and paralytics during mechanical ventilation. Poor response to stimulation and nonresponsiveness after wearing off sedation prompted neuroimaging in these patients, which revealed stroke. Incidentally, all these patients had hypernatremia when stroke was diagnosed. This case series suggests that stroke should be considered a possible cause in all COVID-19 patients presenting with abnormal or altered sensorium.

2.
Ann Indian Acad Neurol ; 23(3): 261-264, 2020.
Article in English | MEDLINE | ID: covidwho-1389615

ABSTRACT

BACKGROUND: Recent respiratory infection including SARS-CoV-2 is an independent risk factor for acute cerebrovascular disease. PURPOSE: There have been reports linking haemorrhagic strokes to SARS-CoV-2 infection during this pandemic, which lead us to evaluate if SARS-CoV-2 infection could be associated with increased risk of intracerebral haemorrhage (ICH). METHODS: A retrospective observational study evaluating all stroke cases admitted in our centre in the past one month. RESULTS: More than half (56%) had ICH, compared to 22% last year. Two patients with ICH were SARS-CoV-2 positive and they had no or mild respiratory symptoms and had higher occurrence of renal dysfunction. CONCLUSION: There could be possible association between ICH and SARS-CoV-2 infections. However, a prospective study with larger sample size is needed to elucidate the pathogenesis.

3.
Int J Infect Dis ; 110: 226-228, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1322131

ABSTRACT

Acanthamoebic encephalitis is a rare and highly fatal disease that has no standard management protocol. Coronavirus disease 2019 (COVID-19) causes immune dysfunction and may predispose patients to this infection. The present study describes successful management of acanthamoebic encephalitis in a young male who recently recovered from COVID-19 using a combination of medical and surgical approaches. A combination of miltefosine with other agents with trophicidal and cysticidal activities should be used in the regimen. Surgical excision of the abscess should be undertaken whenever feasible.


Subject(s)
COVID-19 , Encephalitis , Humans , Male , SARS-CoV-2
4.
J Neurol Sci ; 428: 117583, 2021 09 15.
Article in English | MEDLINE | ID: covidwho-1313266

ABSTRACT

BACKGROUND: As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected. AIMS: The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019. METHODS: The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points. RESULTS: A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods. CONCLUSIONS: Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.


Subject(s)
COVID-19 , Stroke , Communicable Disease Control , Humans , India/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/epidemiology , Stroke/therapy , Time-to-Treatment
5.
Ann Indian Acad Neurol ; 24(1): 11-14, 2021.
Article in English | MEDLINE | ID: covidwho-1150828

ABSTRACT

The ongoing COVID-19 pandemic has precipitated a global health crisis. Non-COVID diseases across specialties have been significantly compromised. The greatest challenge has been to continue providing care to non-COVID cases with minimum transmission risk to health care workers, patients, and caregivers. In this specter, better described as a medical holocaust, we present our experiences of dealing with acute neurological patients who could access our facility. We attempted to work on three key areas - initial screening using a more inclusive, dynamic checklist for COVID suspicion over and above the emergency triage, a mandatory initial holding on a separate floor of our inpatient service equipped with infection control strategies similar to a COVID-designated area, and daily screening of health care workers and caregivers for symptoms and possible exposures. It was a steep learning curve, a couple of close shaves, and many more lessons that went into the development of an algorithm that seems to be working well.

6.
Ann N Y Acad Sci ; 1473(1): 3-10, 2020 08.
Article in English | MEDLINE | ID: covidwho-1030196

ABSTRACT

Stroke care in India has evolved rapidly in the last decade with a focus on stroke awareness, prevention, rapid triage, treatment, and rehabilitation. But acute stroke care and poststroke rehabilitation in the country have limitations owing to the economic constraints and poor access to health care. The SARS-CoV-2/COVID-19 pandemic has made stroke care even more challenging. We outline the unfavorable circumstances in stroke care induced by the pandemic; propose mitigating measures; crisis management; and provide a comparative evaluation of stroke care between India and the United States during the pandemic. There is a need for public health systems in both developed and developing countries to improve awareness, implement proper strategies of triage, acute treatment, well-defined rehabilitation plans, telemedicine services, and virtual check-ins.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Pandemics/prevention & control , SARS-CoV-2 , Stroke/epidemiology , Stroke/therapy , Health Services Needs and Demand/trends , Humans , India/epidemiology , Telemedicine/methods , Telemedicine/trends , United States/epidemiology
8.
J Stroke ; 22(3): 324-335, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-854517

ABSTRACT

BACKGROUND AND PURPOSE: Various neurological findings including stroke in patients with coronavirus disease 2019 (COVID-19) have been described, although no clarity exists regarding the nature and pattern of this association. This systematic review aims to report the characteristics of stroke in patients with COVID-19. METHODS: Three authors independently searched Web of Science, Embase, Scopus, and PubMed starting from inception up to May 22, 2020. The data for individual patients was extracted where available from published reports including clinical and laboratory parameters and analysed for any significant associations between variables. RESULTS: We identified 30 relevant articles involving 115 patients with acute or subacute stroke with COVID-19. The mean±standard deviation age was 62.5±14.5 years. Stroke was ischemic in majority of the patients (101 [87.8%]). Hypertension (42 [42%]), dyslipidaemia (24 [26.1%]), and diabetes (23 [23.2%]) were the major vascular risk factors. Most of the patients (80 [85.1%]) had COVID-19 symptoms at the time of stroke with a median interval of 10 days to stroke from the diagnosis of COVID-19. Three-fourths (86 [74.8%]) of the patients were critically ill which frequently delayed the diagnosis of stroke. High levels of D-dimer, and ferritin were observed in these patients. Patients with COVID-19 and stroke had a high mortality (47.9%). Factors associated with mortality were intensive care unit admission, having two or more vascular risk factors, particularly smoking and high levels of D-dimer, C-reactive protein, and lactate dehydrogenase. CONCLUSIONS: The association between stroke and COVID-19 is probably multifactorial including an amalgamation of traditional vascular risk factors, proinflammatory and a prothrombotic state. Prospectively collected data is required in the future to confirm this hypothesis.

9.
Ann Indian Acad Neurol ; 23(3): 318-324, 2020.
Article in English | MEDLINE | ID: covidwho-623113

ABSTRACT

Stroke is a serious neurological comorbidity observed during the ongoing COVID-19 (coronavirus associated disease 2019) pandemic caused by SARS-CoV-2 (severe acute respiratory syndrome, corona virus 2) and includes ischemic stroke, intracerebral haemorrhage and cerebral venous thrombosis. We reviewed factors that could potentially contribute to the occurrence of stroke among patients with COVID-19. There could be an interaction between the conventional risk factors of stroke, infection, systemic inflammatory response and plaque destabilisation. Inflammatory markers, D-dimer elevation and increased cytokine activity have been observed in patients with COVID-19. Other probable contributing factors include cardiac injury leading to embolism, a prothrombotic state and a possibility of direct neuroinvasive potential causing vasculopathy. Data from stroke patients gathered in large multicentric cohorts could help shed more light on the occurrence, behaviour, aetiology, pathophysiology, biomarkers and outcomes of stroke occurring during the ongoing pandemic.

10.
Ann Indian Acad Neurol ; 23(Suppl 1): S5-S14, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-316385

ABSTRACT

Knowledge related to SARS-CoV-2 or 2019 novel coronavirus (2019-nCoV) is still emerging and rapidly evolving. We know little about the effects of this novel coronavirus on various body systems and its behaviour among patients with underlying neurological conditions, especially those on immunomodulatory medications. The aim of the present consensus expert opinion document is to appraise the potential concerns when managing our patients with underlying CNS autoimmune demyelinating disorders during the current COVID-19 pandemic.

11.
Ann Indian Acad Neurol ; 23(Suppl 1): S15-S23, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-316384

ABSTRACT

The ongoing pandemic of COVID-19 is a global public health emergency. This has led to challenges for healthcare facilities to optimally manage other important medical emergencies. Stroke is an important public health emergency with significant mortality and morbidity. Timely treatment of acute stroke is critical to prevent disability. The current expert consensus statement on behalf of the Indian Stroke Association outlines the issues and suggestions related to the management of stroke during this ongoing COVID-19 pandemic.

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