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Background: Stroke is the leading cause of death and disability worldwide. In COVID-19 pandemic, stroke remains to be a medical emergency. To treat patients with acute ischemic stroke [AIS], early intravenous thrombolysis is highly time sensitive. This research investigated the impact of regionally imposed social and healthcare restrictions of COVID-19 on the time metrics in the management of AIS patients admitted at the stroke unit center in Srinagarind Hospital. Objective(s): Comparison of door to needle time for intravenous thrombolysis for AIS patients before and after the COVID-19 outbreak. Material(s) and Method(s): The present study is a retrospective analysis of patients with AIS who received intravenous tissue plasminogen activator [tPA] from 1 January 2019 to 31 December 2020 in Srinagarind Hospital, Khon Kaen. The patients admitted before and after the COVID-19 outbreak [January 13, 2020, as officially announced by the World Health Organization] were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and to compared door-to-needle time (DNT) for intravenous thrombolysis before and after the outbreak. Result(s): A total of 239 patients were included, of which 113 were enrolled before and 126 after the COVID-19 outbreak. According to the findings, DNT is 35.3 minutes before the pandemic and 35.8 minutes after the epidemic. Conclusion(s): COVID-19 has remarkable impacts on the management of AIS. However, DNT for before and after COVID-19 outbreak is nearly identical. It was established that administering intravenous thrombolysis to patients in the emergency room rather than the stroke unit allowed for speedier access. Therefore, a policy which provides quick AIS treatments in COVID-19 situations should be implemented.Copyright © 2023 Journal of the Medical Association of Thailand.
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COVID-19 patients have presented with a wide range of neurological disorders, among which stroke is the most devastating. We have reviewed current studies, case series, and case reports with a focus on COVID-19 patients complicated with stroke, and presented the current understanding of stroke in this patient population. As evidenced by increased D-dimer, fibrinogen, factor VIII and von Willebrand factor, SARS-CoV-2 infection induces coagulopathy, disrupts endothelial function, and promotes hypercoagulative state. Collectively, it predisposes patients to cerebrovascular events. Additionally, due to the unprecedented strain on the healthcare system, stroke care has been inevitably compromised. The underlying mechanism between COVID-19 and stroke warrants further study, so does the development of an effective therapeutic or preventive intervention.
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Introduction: COVID-19 seems to induce ischemic stroke by several potential mechanisms including promoting hypercoagulability, and worse functional outcomes have been reported in patients with stroke and the infection with SARS-CoV-2. Objective(s): Determine the association between functional outcome and COVID-19 in patients with stroke. Patients and Methods: We performed a case control study comparing patients admitted to a neurological reference center in Peru with a diagnosis of stroke before (controls) and after (cases) the onset of the COVID-19 pandemic. There were 31 cases diagnosed with COVID-19 and 62 controls without COVID-19. Bivariate analysis and conditional fixed-effects Poisson regression analysis were used to evaluate the association between the functional outcome of the stroke and COVID-19. Result(s): Cases had higher baseline serum glucose (133.5, IQR: 117.5-174 versus 117, IQR: 101-130, p = 0.033) than controls, higher neutrophil counts (7.91, IQR: 5.93-9.57 versus 5.96, IQR: 4.41-7.79, p = 0.008), lower lymphocyte counts (1.48, IQR: 1.04-1.8 versus 1.83, IQR: 1.26-2.32, p = 0.025), higher neutrophil/lymphocyte ratios (5.44, IQR: 4.0-8.1 versus 3.29, IQR: 2.25-6.02, p = 0.011), higher NIH stroke scale/score (NIHSS) (14, IQR: 9-18 versus 7 IQR: 5-11, p = 0.000), and higher modified Rankin scores at discharge (4, IQR: 4-5 versus 2, IQR: 1-4), p = 0.001). Seven (21.88%) participants died in the group of cases versus 1 (1.56%) in the controls (p = 0.014). The odds ratio of having a bad functional outcome at discharge was 1.344 (CI: 1.079-4.039;p = 0.029), adjusted by NIHSS at admission. Conclusion(s): Our findings suggest that ischemic strokes associated with COVID-19 are more severe, have worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.Copyright © 2023 Sociedad Neurologica Argentina
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Introduction Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current pen-and-paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Methods Patients are approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have preexisting condition i.e dementia, severe aphasia Participants could speak to the digital doctor on the ward or at home via a web-version. Results Recruitment started on 8th December 2020;We have screened 614 people assessed for suspected acute stroke/TIA at Sheffield Teaching Hospitals. Of those we have recruited 71 participants (13 with TIA) Mean NIHSS of 4.5 and mean MoCA of 24.6. We will present initial results of factors affecting participant recruitment. We will also compare the mood and anxiety screening scores used in this study to those collected via the SNAPP database. Discussion Screening was adapted due to Covid pandemic and utilising remote consent and participa- tion allowed the project to continue.
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Background: The Coronavirus Disease 2019 (COVID-19) pandemic had disrupted established medical care systems worldwide, especially for highly time-sensitive acute conditions such as stroke. Strategies to maintain the quality of stroke care during the COVID-19 outbreak are crucial to prevent indirect mortality and disability due to suboptimal care. Objective: We conducted a single center analysis to compare the time-based measures for acute ischemic stroke care quality before and during the COVID-19 pandemic. Methods: A retrospective study was done utilizing the Registry of Stroke Care Quality (RES-Q) database. All acute ischemic stroke patients who presented within 4.5 hours of symptom onset in Makati Medical Center were included. Patient characteristics, treatment received, in-hospital time-based measures of stroke care quality and clinical outcomes were compared between the two periods-pre-COVID-19 and COVID-19. Results: There were 151 patients during the pre-COVID-19 period and 108 patients during the COVID-19 period who presented to the hospital with acute ischemic strokes within 4.5 hours of symptom onset. There was significantly higher NIHSS scores on admission and MRS scores on discharge during the COVID-19 period. There was no significant difference in the door-to-scan time, door-to-needle time and door-to-groin time between the two periods. Conclusion: There is no significant change in the acute ischemic stroke care quality on the basis of in-hospital time-based measures: door-to-scan time, door-to-needle time, and door-to-groin time, between the pre-COVID-19 and COVID-19 periods. Further studies on pre-hospital challenges are recommended to identify specific targets for improvements in stroke care during pandemics. © 2023, ASEAN Neurological Association. All rights reserved.
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Background: COVID-19 infection is associated with multi-organ involvement. Neurological manifestations are seen in COVID-19 infection due to endothelial damage and prothrombotic state. Thus the importance of early detection or identifying the patients with high risk for developing cerebrovascular manifestations that could end up in disability and a worse overall prognosis has lead to the study of stroke characteristics in association with COVID-19. Objective(s): To study the acute cerebrovascular accident (CVA) manifestations in patients infected with coronavirus disease 19 (COVID-19). Methods and Materials: Our study is a retrospective from July 2020 to September 2020 for a period of 3 months done in confirmed Covid-19 infection (SARS-CoV-2 RT-PCR-positive) who are admitted in our tertiary care hospital. Diagnosing of stroke was confirmed either by Computed Tomography(CT) or Magnetic Resonance Imaging (MRI) of the brain. The inclusion criteria were as follows: RT PCR confirmed Covid 19 cases, who developed acute cerebrovascular accident in the patient. Exclusion Criteria Include: Known case of stroke, hyperlipidemia, diabetes mellitus, hypertensive cases and morbid obesity patients. Result(s): Out of 8489 covid-19 confirmed cases in our hospital nearly 10 cases developed neurological manifestations who had no other co morbidities or risk factors. Out of 10 patients, 7 patients were male and 3 patients were female. Out of 10 cases 20% of cases were among the age group of 25-40 years of age, another 70% belongs to 40-50 years of age & 10% of cases belongs to age group 50-60years. Thus majority of our cases were around age group 40-50 years. Majority of our patients (60%) developed cerebrovascular accident on day 3-6 of onset of symptoms. All our patients had high sensitivity C-reactive protein above 10mg/ml and 60% had their serum ferritin value >550ng/ml. Majority of our patients had their D-dimer value >10000ng/ml. Most of our patients(50%) belongs to severe category of National Institute of Health Stroke Scale (NIHSS).Majority of our patients who developed stroke had improved (70%), nearly 10% had no improvement and 20% died. All our patients developed ischemic stroke. Conclusion(s): From our study we seen that middle aged male between 40-50 yrs. who are infected with covid-19 infection with no comorbiditites and with higher inflammatory markers had developed ischemic stroke when compared to the usual age >60 years with comorbidities in non-covid patients. Thus we conclude that covid 19 infection is to be considered as an individual risk factor for developing stroke. D-dimer level more than 3 fold increase and high C-reactive protein should alarm the physician to start on early treatment of steroids and anticoagulants.. Thus early detection of inflammatory markers and early start of anticoagulants and steroids resulted in good outcome of the patients. Repeat inflammatory markers should be done at the end of the treatment and if it is still elevated, patient should be discharged with oral steroids, antiplatelets and statins even with no comorbidities and symptoms. Anyhow studies with bigger sample size is needed to validate these results.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Objective: To describe ischemic stroke due to floating thrombus of ascending aorta occurring as acute and subacute complication of SARS-CoV-2 infection. Material(s) and Method(s): consecutive identification in clinical practice of ischemic strokes secondary to aortic arch thrombosis and history of acute or recent Covid-19 infection. Result(s): two patients had ischemic stroke with evidence of aortic arch thrombosis. The first case had concomitant acute Covid-19 infection, the second had recent Covid-19 infection. Both patients underwent intravenous thrombolysis, and subsequent anticoagulation. One patient died due to cerebral hemorrhage. Discussion and Conclusion(s): aortic arch thrombosis can be an incidental finding in acute ischemic stroke in patients with concomitant and recent COVID-19 disease. However, the infection may lead to thrombosis in non-atherosclerotic vessels and to cerebral embolism. Our findings support active radiological search for aortic thrombosis during acute stroke in patients with acute or recent COVID-19 disease.Copyright © 2022
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Introduction: Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current penand- paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Method(s): Patients were approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have pre-existing medical condition i.e dementia, severe aphasia or too medically unwell to complete the assessment. Participants completed the computerised doctor or "CognoSpeak" on the ward using a tablet or at home via a web-version (on home computer or tablet). The assessment included the GAD and PHQ9. All had standard cognitive assessment done with the Montreal Cognitive Assessment (MOCA). Result(s): Recruitment started on 8th December 2020 and is on-going. 951 people were screened and 104 were recruited. 49 have completed baseline Cognospeak, 8 have withdrawn and 3 have died. The mean NIHSS was 3.8 and mean MoCA of 23.9, 31 were female. Participants had a mean education level of 17 years. Conclusion(s): Preliminary data will be presented highlighting feasibility of an automated cognitive and mood assessment that can be completed at home and on the Hyper-acute Stroke Unit. Screening was adapted due to Covid pandemic and utilising remote consent and participation allowed the project to continue.
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Background and Purpose: With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. However, there is limited data on the clinical characteristics, stroke mechanism, and outcomes of patients who have a stroke and COVID-19. Method(s): We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 15, 2020, and April 19, 2020, within a major health system in New York, the current global epicenter of the pandemic. We compared the clinical characteristics of stroke patients with a concurrent diagnosis of COVID-19 to stroke patients without COVID-19 (contemporary controls). In addition, we compared patients to a historical cohort of patients with ischemic stroke discharged from our hospital system between March 15, 2019, and April 15, 2019 (historical controls). Result(s): During the study period in 2020, out of 3556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to contemporary controls (30.4%, P=0.003) and historical controls (25.0%, P<0.001). When compared with contemporary controls, COVID-19 positive patients had higher admission National Institutes of Health Stroke Scale score and higher peak D-dimer levels. When compared with historical controls, COVID-19 positive patients were more likely to be younger men with elevated troponin, higher admission National Institutes of Health Stroke Scale score, and higher erythrocyte sedimentation rate. Patients with COVID-19 and stroke had significantly higher mortality than historical and contemporary controls. Conclusion(s): We observed a low rate of imaging-confirmed ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased. Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.
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Introduction: Covid-19 pandemic had significant impact on stroke care management and reduced the number of stroke admissions. A delay in treatment resulted in a more severe stroke with higher morbidity and mortality. Objective(s): To determine impact of Covid- 19 on the total number of admissions of stroke patients, compare ischemic stroke standard of care and outcome before and during Covid-19 pandemic. Methodology: A retrospective record review study. Data of patients with radiologically and - /or clinically confirmed AIS in HUSM who were diagnosed from 1st March 2019-28th February 2021 were recorded. Those who fulfilled the criteria were included in the study. Result(s): 229 patients were involved in this study;114 (49.8%) patients in the pre-Covid-19 period, and 115 (50.2%) patients during Covid-19 period. NIHSS score was similar, 5.3 +/- (4.18) in 2019 and 5.9 +/- (4.42) in 2020. There was no difference in terms of onset to door time between the two groups. However, we noticed a significant delay of onset to door time in both groups: 1875.2 min (31.25) hours in pre- Covid-19 vs. 1827.1 (30.45) hours during Covid-19 group (t. test 0.17, p = 0.863). The waiting time to see an ED (in minutes) dropped from 25.3 (30.21) during pre -Covid-19 period vs. 22.6 (16.48) in Covid- 19 group (t. test 0.48, p = 0.402). Door to CT brain time was 83.8 (58.91) vs 92.4 (120.20) during pre-Covid and Covid group (t. test -0.69, p = 0.493). There was a sharp decrease in patients who seek thrombolytic therapy from 7(6.1%) during pre-covid-19 to 4 (3.5%) during Covid-19 period (p = 0.354). As physiotherapy, occupational therapy, speech therapy assessment, the results are as follows;(77.2% vs. 81.7% p = 0.372), (76.3% vs. 81.7% p = 0.334), (50% vs. 59.1% p = 0.185), (43.9% vs. 45.2% p = 0.894) respectively. The duration of hospital stay was (6.4 +/- 4.5 vs. 7.5 +/- 6.74 (t. test -1.36, p = 0.175). MRS score at discharge was [2.8 (1.38) vs 2.9 (1.49)] (t. test -0.33 p = 0.742) for pre-Covid-19 and during Covid-19 group. Conclusion(s): The Covid-19 pandemic had no significant impact on stroke management and neurological outcomes for patients seeking treatment in HUSM.Copyright © 2023
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Background Left Ventricular Non-Compaction Cardiomyopathy (LVNC) is a rare genetic, developmental disorder when the left apical chamber of the heart contains bundles or pieces of muscle that extend into the chamber called trabeculations. These trabeculations are a sponge-like network of muscle fibers that typically become compacted to transform heart muscle to become smooth and solid during a normal development process. Those who have LVNC most commonly are asymptomatic. Those who are symptomatic present with syncope, palpitations, dizziness, dyspnea, fatigue and/or unexplained weight gain or swelling. LVNC has also been suggested as a rare cause of embolic stroke, in our patient's case, "due to sluggish blood flow in deep intertrabecular recesses." Case We present a 29 year old African American female, G2P0011, with a history of cleft palate repair, and recent pregnancy complicated by COVID-19 who reported to ED after having a fall the day before, leg weakness and numbness, unable to walk, headache and a left facial droop on day of admission. No family history of SCD or other cardiac disease was noted. On assessment, was found to have NIHSS of 7 with rate lateral gaze palsy, left facial palsy, and decreased strength and sensation of LUE and LLE. TPA was not given due to being outside the therapeutic window. CT head and MRI brain were consistent with acute right MCA stroke. Secondary stroke workup with TTE revealed reduced LVEF 15-20%, loosely arranged myocardium with suspected LVNC and RV apical thrombus. Cardiac MRI showed increased trabeculations consistent with LVNC. Decision-making Currently, there are no ACC/AHA guidelines on anticoagulation in the setting of LVNC. Cardiology and Neurology had an extensive multidisciplinary discussion on the need for anticoagulation specifically with Warfarin. The patient was educated extensively on the need for medical adherence with anticoagulation and guideline directed medical therapy. Conclusion The patient was started on guideline directed medical therapy for cardiomyopathy and was started on Warfarin after bridging from Lovenox. She continued with physical therapy and was noted to have improvement in residual deficits at her outpatient follow up.Copyright © 2023 American College of Cardiology Foundation
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Background: A growing body of international research suggests the prevalence of upper limb weakness early after stroke is currently lower (40-57%) than widely cited values of 70-80% from two decades ago. Recent work also indicates the distribution of upper limb weakness may be bimodal, with a higher proportion of people with severe or little/no weakness as compared to mild/moderate weakness. Aim: To describe the prevalence and distribution of upper limb weakness early post-stroke. Methods: Patients admitted to a tertiary acute stroke unit with a suspected stroke were screened between November 2018 to February 2020 (interrupted by COVID-19) and April to November 2021. Upper limb weakness was captured via Shoulder Abduction and Finger Extension (SAFE) score (0-10), which was prospectively assessed at first contact by the unit therapist. Data on stroke type, acute medical intervention received, and National Institute of Health Stroke Scale (NIHSS) were also extracted. Results: A total of 662 individuals with confirmed stroke (median NIHSS score 6, IQR 2-13) were administered SAFE a median 1 (IQR 1,2) day after unit admission. Only 46.2% had upper limb weakness (SAFE score ≤9). Three most common SAFE scores were 10 (53.8%), 8 (11.5%) and 0 (9.4%). The subgroup severity distribution was 59.2% little to no impairment (SAFE 9-10), 24.1% mild to moderate impairment (SAFE 5-8), and 16.7% severe impairment (SAFE 0-4). Approximately one third (29.8%) received ≥1 acute interventions (e.g., thrombolysis, thrombectomy). Data collection remains ongoing, and a larger total sample will be presented. Conclusion: The prevalence of upper limb weakness at this single tertiary centre aligns with recent international data. A better understanding of the upper limb weakness profile will help inform service delivery e.g., shifting resources to subgroups which are more common. Furthermore, it can guide researchers in target population selection in trials, which can enhance generalisability of findings.
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INTRODUCTION: In the coronavirus disease 2019 (COVID-19) pandemic, there may be a decrease in the number of acute stroke intervention and acute treatment, and delays in treatment periods. In this study, it was aimed to compare the clinical features of patients presenting with acute stroke during the COVID-19 pandemic and in the pre-pandemic period. METHODS: Patients hospitalized with the diagnosis of cerebrovascular disease (CVD) between January 01, 2019 and May 31, 2021 were included in the study. Demographic characteristics and stroke risk factors of the patients were recorded. Stroke type and ischemic disease subtypes were determined, and patients' admission National Institutes of Health Stroke Scale (NIHSS) score, symptom-door time, door-consultation time, door-to-door Needle time and door-groin puncture time, intravenous tissue type plasminogen activator (IV tPA) and endovascular thrombectomy (EVT) applications were recorded. Discharge modified Rankin Scale (mRS) and NIHSS scores and mortality rates were evaluated. Patients hospitalized in two separate periods of 14 months each were compared by dividing them into pre-pandemic and pandemic periods. RESULTS: Before COVID-19, 316 patients (female 45.25%, age: 66.75±13.68 years) and during the pandemic period 341 (female 41.94%, age: 68.34±13.55 years) patients were included in the study. During the pandemic period, an increase in the number of hemorrhagic CVD and transient ischemic attacks, a decrease in the number of ischemic stroke and cerebral venous thrombosis (CVT) hospitalizations, a decrease in cardioembolic strokes and an increase in lacuner ischemic CVD subtypes were observed (p<0.01). The number of large vessel atherosclerosis, IV tPA and EVT were found to be similar before and after the pandemic. In the pandemic period, although it did not reach statistical significance compared to the pre-pandemic period, prolongation was recorded in the symptom-door, door-consultation, door-needle and door-groin puncture times (p>0.05). The COVID-19 test was positive after hospitalization in 5 (1.8%) patients with ischemic stroke hospitalized during the pandemic period. During the pandemic period, admission NIHSS, discharge NIHSS and mRS scores and mortality rates were found to be significantly higher between hemorrhagic and ischemic stroke patients (p<0.01). DISCUSSION AND CONCLUSION: The COVID-19 pandemic adversely affects the management of acute stroke. The duration of acute stroke treatment is delayed due to pre-hospital and in-hospital reasons. With the heavy burden of stroke during the pandemic period, poor clinical outcome and high mortality are observed.
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Introduction/Purpose Over the past few years, transradial access for neurointerventions has gained more popularity due to extrapolated interventional cardiology data, patient preference and early reports of feasibility using this approach. Our aim was to evaluate the incidence of periprocedural stroke in patients undergoing radial versus femoral access for diagnostic cerebral angiograms. Materials and Methods Retrospective review of our prospectively maintained neurointerventional database and identification of all patients who underwent a diagnostic cerebral angiogram between May 2019 and July 2021. These patients were further divided into radial versus femoral access. Patients in whom postprocedural stroke symptoms were identified were recorded. In those patients, symptoms and NIHSS were collected. Pertinent laboratory values and procedural data was reviewed, including COVID status, platelet count, INR, GFR, vessels catheterized, amount of contrast used, and fluoroscopy time. Patient imaging work-up for stroke symptoms was reviewed, if available. Results A total of 1238 diagnostic cases were performed between table 1 for a detailed overview. Conclusion In our experience, transradial access for diagnostic cerebral angiograms was associated with a low but not neglectable incidence of periprocedural strokes when compared to the traditional femoral approach. Patient vascular anatomy should be evaluated prior to selection of vascular access and patients should be made aware of the possibility of a slightly higher possibility of periprocedural stroke with transradial access. (Figure Presented).
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Background: Pandemics may promote hospital avoidance among patients with emergencies, and added precautions may exacerbate treatment delays. Methods: We used linked administrative data and data from the Quality Improvement and Clinical Research Alberta Stroke Program - a registry capturing stroke related data on the entire Albertan population (4.3 million) - to identify all patients hospitalized with stroke in the pre-pandemic (01/01/2016-27/02/2020) and COVID-19 pandemic (28/02/ 2020-30/08/2020) periods. We examined changes in stroke presentation rates and use of thrombolysis and endovascular therapy (EVT), adjusted for age, sex, comorbidities, and preadmission care needs;and in workflow, stroke severity (National Institutes of Health Stroke Scale/NIHSS), and in-hospital outcomes. Results: We analyzed 19,531 patients with ischemic stroke pre-pandemic versus 2,255 during the pandemic. Hospitalizations/presentations dropped (weekly adjusted-incidencerate-ratio[aIRR]:0.48,95%CI:0.46-0.50), as did population-level incidence of thrombolysis (aIRR:0.49,0.44-0.56) or EVT (aIRR:0.59,0.49-0.69). However, proportions of presenting patients receiving thrombolysis/EVT did not decline (thrombolysis:11.7% pre-pandemic vs 13.1% during-pandemic, aOR:1.02, 0.75-1.38). For out-of-hospital strokes, onset-to-door times were prolonged(adjusted-coefficient:37.0-minutes, 95%CI:16.5-57.5), and EVT recipients experienced greater door-to-reperfusion delays (adjusted-coefficient:18.7-minutes,1.45-36.0). NIHSS scores and in-hospital mortality did not differ. Conclusions: The first COVID-19 wave was associated with a halving of presentations and acute therapy utilization for ischemic stroke at a population level, and greater pre-/in-hospital treatment delays. Our data can inform public health messaging and stroke care in future pandemic waves.
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Background and aims: Anticoagulation on CVT is followed until 6 to 12 months according to guidelines. Longer periods of treatment are used in patients with high thrombotic risk. We describe the duration of treatment with OAC and what risk factors are related to longer treatment. Methods: We conducted a retrospective single centre study in a tertiary hospital in México City. Electronic medical files of consecutive patients with CVT were reviewed from January 2018 to June 2020. Clinical, radiological and laboratory variables were obtained. Patients were allocated according to the time of use of OAC (less or more than a year). Results: We collected data from 20 patients. 14 (70%) were female, with a mean age of 33.5 (26-50). 40% (n=8) were smokers, 20% (n=4) used hormonal contraceptives, 15% (n=3) were pregnant or in puerperium and 10% (n=2) referred vaccination for SARS-CoV-2. superior sagittal sinus was the most frequently affected (65%). The median time of AOC treatment was 13 months (6.7-16.7). In the bivariate analysis, the existence of a chronic cause (OR 14;IC95%, 1.25-156;p= 0.028), and prolonged hospitalization (OR 15.7;IC95% 1.7-141.4 p= 0.22) were associated with AOC treatment over a year. Initial NIHSS, mRS at discharge, D-dimer values or seizures al presentation showed no correlation. Conclusion: Use of OAC in a tertiary centre is related to chronic conditions with high thrombotic risk and with long hospital stay, according to the guideline's recommendations.
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Background and aims: Ischemic stroke is a remarkable cause of death and disability worldwide. Post-stroke depression (PSD) is the most common psychiatric disturbance after stroke. Despite PSD being a potentially treatable condition, it still requires approaches to improve the early diagnosis. The present study aims to investigate the predictors and correlated variables associated with PSD during hospitalization. Methods: A cross-sectional study was carried out in a specialized center of neurology situated at Santa Catarina, Brazil. 148 patients with acute ischemic stroke hospitalized between January 2020 and February 2021 were included. Sociodemographic, clinical and radiological variables were assessed during hospitalization. The Hospital Anxiety and Depression Scale (HADS) was applied, as well as the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Predictors factors were investigated through binary logistic regression and continuous variables through correlation tests. Results: The prevalence of PSD during hospitalization was 31.1%. Predictors of PSD in the acute phase of the stroke were female sex (OR: 2.6;CI 95%: 1.3 to 5.4;p<0.01) and post-stroke anxiety during hospitalization (OR: 4.9;CI 95%: 2.3 to 10.3;p<0.01). The variables NIHSS, mRS, and stroke area were positively correlated with HADS - depression values. Conclusion: This research evidenced a high prevalence of PSD in the acute phase of stroke. Despite the study being conducted during the COVID-19 pandemic, the data found is similar to the non-pandemic periods. The research provided clues to identify and early treat patients at greater risk of developing PSD during hospitalization.
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Background and aims: Hyperglycaemia in acute ischaemic stroke (AIS) is common, reduces the efficacy of stroke thrombolysis and thrombectomy, with worse clinical outcomes. Insulin therapies are difficult to implement and maintain, and may cause symptomatic hypoglycaemia. An alternative treatment is Exenatide, a GLP-1 agonist that lowers blood glucose with a very low risk of hypoglycaemia. Methods: The Trial of Exenatide in Acute Ischaemic Stroke (TEXAIS) enrolled adult patients with AIS ≤9 hours of stroke onset to receive treatment with short-acting Exenatide (5μg bid subcutaneous injection) or Standard care for 5 days, or until hospital discharge (whichever sooner).Primary outcome: proportion of patients with ≥8 point improvement in NIHSS score (or NIHSS 0-1) at 7 days. Results: 350 patients randomised, median age 71 years (IQR 62, 79), and median NIHSS 4 (IQR 2, 8). Planned recruitment (n=528) stopped early due to Covid and time constraints. On Admission the median blood glucose was 6.7 (IQR 5.70, 8.50), and 42% patients had hyperglycaemia (>7.0 mmol/L). Primary outcome occurred in 97/171 (56.7%) in Standard care group vs 104/170 (61.2%) in Exenatide group [aOR: 1.22 (CI 0.79, 1.88) p=0.38]. Mean daily per-patient frequency of hyperglycaemia was significantly less in the Exenatide group (p=0.002). No episodes of hypoglycaemia reported over the treatment period. Nausea/vomiting occurred in 7/174 (4.0%) patients on Exenatide. Conclusions: In this Phase 2 trial Exenatide did not significantly reduce neurological disability at 7 days. Exenatide significantly reduced frequency of hyperglycaemic events, and was safe to use. These results warrant further investigation with larger Phase 3 trials.
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Background and aims: Optimal management of carotid artery freefloating thrombus (CAFFT) and CAFFT-related strokes remains unclear. We sought to examine the clinical characteristics, treatment strategies and patient outcomes for CAFFT-related ischaemic strokes. Methods: We conducted a single-centre retrospective observational study by extracting data from electronic patient records. We included consecutive patients admitted between 2016-2021 with ischaemic stroke and CAFFT on initial CT/MR angiogram. Results: We included 59 patients (mean age 63, 66% male). Vascular risk factors included hypertension (42%), diabetes (19%), dyslipidaemia (27%), previous stroke (10%), smoking history (56%) and alcohol excess (14%). 6 patients (10%) were COVID-19 positive. Median modified Rankin score was 0 and mean NIHSS was 11. On admission, 42% were taking antiplatelet agents, 10% were on anticoagulant, 34% had CRP >10mg/L, and 14% had eGFR <50 ml/min/1.73m2. On arrival, 27% received IV thrombolysis and 19% underwent mechanical thrombectomy. Acute antithrombotic strategies included IV heparin (49%), low molecular weight heparin (47%), oral anticoagulation (15%), and antiplatelet agents (63%). 24 patients (41%) were referred to vascular surgery, of whom 9 (38%, 15% of total) received emergency carotid endarterectomy. Neurological deterioration (<7 days) occurred in 14%. In-hospital mortality was 8% overall, but 67% for COVID-positive patients. At 6 months, recurrent stroke occurred in 12% and mortality was 3%. Conclusions: CAFFT-related ischaemic stroke is associated with significant mortality and neurological morbidity. The use of different acute antithrombotic strategies and emergency carotid endarterectomy varied significantly between patients. These major treatment options should be subjects of future clinical trials.