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1.
Journal of Stroke and Cerebrovascular Diseases ; 31(6), 2022.
Article in English | EMBASE | ID: covidwho-1799803

ABSTRACT

Background: The relationship between cardiac function and mortality after thrombectomy for acute ischemic stroke is not well elucidated. Methods: We analyzed the relationship between cardiac function and mortality prior to discharge in a cohort of patients who underwent thrombectomy for acute ischemic stroke at two large medical centers in New York City between December 2018 and November 2020. All analyses were performed using Welch's two sample t-test and logistic regression accounting for age, initial NIHSS and post-procedure ASPECTS score, where OR is for each unit increase in the respective variables. Results: Of 248 patients, 41 (16.5%) died prior to discharge. Mortality was significantly associated with higher initial heart rate (HR;89 ± 19 bpm vs 80 ± 18 bpm, p = 0.004) and higher maximum HR over entire admission (137 ± 26 bpm vs 114 ± 25 bpm, p < 0.001). Mortality was also associated with presence of NSTEMI/STEMI (63% vs 29%, p < 0.001). When age, initial NIHSS score, and post-procedure ASPECTS score were included in multivariate analysis, there was still a significant relationship between mortality and initial HR (OR 1.03, 95% CI 1.01- 1.05, p = 0.02), highest HR over the entire admission (OR 1.03, 95% CI 1.02-1.05, p < 0.001), and presence of NSTEMI/STEMI (OR 3.76, 95% CI 1.66-8.87, p = 0.002). Conclusions: Tachycardia is associated with mortality in patients who undergo thrombectomy. Further investigation is needed to determine whether this risk is modifiable.

2.
Front Neurol ; 13: 852423, 2022.
Article in English | MEDLINE | ID: covidwho-1785381

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic is having a dramatic impact on acute stroke care. Its effects may accompany stroke care for a long time. We compared the treatment, short-term and long-term functional outcomes of patients with AIS from 2019 to 2020. Our objective was to evaluate the effect of COVID-19 epidemic on mechanical thrombectomy (MT) in patients in our hospital. Methods: We collected information on subjects treated with MT in 2019-2020, including age, sex, time from the onset to arterial sheath insertion, time from the onset to recanalization, the rate of lung infection and hemorrhagic transformation, modified Rankin scale (mRS), NHISS, and ASPECTS. Results: The number of patients with MT decreased significantly by 26.6% in 2020 (p = 0.025). The pretreatment ASPECTS score for 2020 was significantly higher than 2019 (p = 0.004). Besides, the patients were more likely to develop lung infection (65 vs. 54.1%, p = 0.042) and had a higher risk of hemorrhagic transformation (47.4% vs. 30.4%, p = 0.005) in 2019. The discharged mRS reflected the worse short-term functional prognosis of patients with MT in 2019 (66 vs. 44.9%, p = 0.046). In the subgroup analysis of bridging thrombolysis (BT), more patients with BT are expected to have a poor short-term functional prognosis in 2020, according to the discharged mRS (62.5 vs. 37.5%, p = 0.024). However, there was no difference in mRS at 180 days between the two groups (p = 0.094). Conclusion: For patients with MT, both short- and long-term functional outcomes were not significantly affected due to the mild condition of patients admitted to hospital in 2020. For patients with BT, the COVID-19 pandemic has prolonged the green channel time of stroke, leading to a poor short-term functional prognosis of patients with stroke in the pandemic period. There was no difference in the effectiveness of direct MT and BT during the COVID-19 pandemic.

3.
Interv Neuroradiol ; : 15910199221093896, 2022 Apr 11.
Article in English | MEDLINE | ID: covidwho-1785091

ABSTRACT

BACKGROUND: The neutrophil-lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19. OBJECTIVE: We sought to describe the role of NLR in predicting poor outcome in COVID-19 patients undergoing mechanical thrombectomy for acute ischemic stroke. METHODS: We analyzed NLR in COVID-19 patients with large vessel occlusion (LVO) strokes enrolled into an international 12-center retrospective study of laboratory-confirmed COVID-19, consecutively admitted between March 1, 2020 and May 1, 2020. Increased NLR was defined as ≥7.2. Logistic regression models were generated. RESULTS: Incidence of LVO stroke was 38/6698 (.57%). Mean age of patients was 62 years (range 27-87), and mortality rate was 30%. Age, sex, and ethnicity were not predictive of mortality. Elevated NLR and poor vessel recanalization (Thrombolysis in Cerebral Infarction (TICI) score of 1 or 2a) synergistically predicted poor outcome (likelihood ratio 11.65, p = .003). Patients with NLR > 7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2-38.6, p = .03) and almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2-52.4, p = .03). In a multivariate analysis, NLR > 7.2 predicted poor outcome even when controlling for the effect of low TICI score on poor outcome (NLR p = .043, TICI p = .070). CONCLUSIONS: We show elevated NLR in LVO patients with COVID-19 portends significantly worse outcomes and increased mortality regardless of recanalization status. Severe neuro-inflammatory stress response related to COVID-19 may negate the potential benefits of successful thrombectomy.

4.
J Formos Med Assoc ; 2022 Feb 14.
Article in English | MEDLINE | ID: covidwho-1739928

ABSTRACT

Psychiatric and neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are common. Psychiatric symptoms are so common that they are easily misinterpreted as an affective disorder induced by SARSCoV-2 infection. However, psychiatric symptoms, such as acute delirium, though rarely seen, can be the initial manifestations of acute ischemic stroke (AIS). These psychiatric symptoms may confuse the diagnosis of acute stroke, which needs correct and timely management. We report two hospitalized cases with SARS-CoV-2 infection and elevated serum D-dimer levels having acute delirium as the initial manifestation of AIS. The diagnostic processes were challenging and time-consuming, so reperfusion therapy could not be given in the therapeutic time window. The diagnoses of AIS were finally made by brain magnetic resonance imaging which showed diffusion restriction at the right middle cerebral artery territory in both cases. Features of psychiatric complications and stroke in coronavirus disease 2019 (COVID-19) patients are reviewed. For the hospitalized COVID-19 patients with elevated levels of serum Ddimer and acute delirium, acute stroke with neuropsychiatric manifestations should beconsidered.

5.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724023

ABSTRACT

Introduction: Recent studies have shown patients with coronavirus disease 2019 (COVID-19) develop significant coagulopathy with thromboembolic complications including ischemic stroke. However, data are sparse regarding the clinical characteristics, stroke mechanism, and patient outcomes. Methods: We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 2020 and June 2021, within at a Regional Medical Center serving three large counties in South Carolina. We further investigated clinical and demographic characteristics, stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS), and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with COVID-19 who also suffered from an acute ischemic stroke. Results: During the study period, out of 1087 hospitalized patients with a diagnosis of COVID-19 infection, 18 patients (1.6%) had an imaging-proven ischemic stroke. Of these 18 patients, 10 (56%) were men, 16 were African-Americans (89%), 2 (11.1%) patients were <55 years of age. All patients had at least one known vascular risk factor. Cryptogenic stroke was more common in patients with COVID-19 (83%). The median time (days) from COVID-19 symptom onset to stroke symptom onset was 11 (IQR 10-28), while the median time from being tested positive for COVID-19 to stroke diagnosis was 10 (IQR 2-24). Our study sample had a median admission NIHSS score of 5 (IQR 3- 11) and a median peak D-dimer level of 2101 (IQR 1349 - 3213). Interestingly, 38% of these patients were already on therapeutic anticoagulation before the diagnosis of stroke. Patients with COVID-19 and stroke had an inpatient mortality rate of 11%. None of these patients met the criteria for IV-tPA treatment or thrombectomy. Conclusion: We observed a modest rate of ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly secondary to coagulopathy associated with COVID-19 infection. Further studies are needed to guide management for stroke prevention in patients with COVID-19.

6.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724021

ABSTRACT

Objectives: Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy). Materials and Methods: We analyzed the data from 62 healthcare facilities to determine the odds of receiving acute revascularization treatments in severe acute respiratory syndrome coronavirus infected patients and odds of composite of death and non-routine discharge with severe acute respiratory syndrome coronavirus infected and non-infected patients undergoing acute revascularization treatments after adjusting for potential confounders. Results: Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments (odds ratio 0.6, 95% confidence interval 0.5-0.8, p=0.0001). Among ischemic stroke patients who received acute revascularization treatments, severe acute respiratory syndrome coronavirus infection was associated with increased odds of death or non-routine discharge (odds ratio 3.0, 95% confidence interval 1.8-5.1). The higher odds death or non-routine discharge (odds ratio 2.1, 95% confidence interval 1.9-2.3) with severe acute respiratory syndrome coronavirus infection were observed in all ischemic stroke patients without any modifying effect of acute revascularization treatments (interaction term for death (p=0.9) or death or non-routine discharge (p=0.2). Conclusions: Patients with acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments. Severe acute respiratory syndrome coronavirus infection was associated with a significantly higher rate of death or non-routine discharge among acute ischemic stroke patients receiving revascularization treatments.

7.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724020

ABSTRACT

Introduction: Venous thromboembolism (VTE) is a common medical complication following acute ischemic stroke (AIS). Studies have suggested that VTE rates were higher among patients with a history of COVID-19. We examined the risk of VTE in AIS patients with and without a history of COVID-19 among Medicare beneficiaries. Methods: We identified Medicare fee-for-service (FFS) beneficiaries aged ≥65 years with AIS hospitalizations from 04/01/2020 to 06/30/2021. COVID-19 cases were identified by the first diagnosis of COVID-19 on a claim at any health care setting. We defined AIS with COVID-19 if the dates of COVID-19 diagnoses were earlier than AIS admission dates. To identify VTE for each AIS admission, we used the following secondary diagnoses codes: ICD-CM-10: I80, I81, I82, I26. We compared the prevalence ratio (PR) of VTE between AIS patients with and without a history of COVID-19. Results: Among 178,830 Medicare FFS beneficiaries with AIS admissions, 6.1% had a history of COVID-19 and 2.6% had VTE as a complication. VTE prevalence among AIS patients with a history of COVID-19 was 3.98% (95% confidence interval (CI), 3.62-4.36%) and 2.53% (95% CI, 2.46- 2.61%) among patients without a history of COVID-19. The adjusted PR of VTE was 1.55 (95% CI, 1.40-1.70, p<0.001) comparing AIS admissions with a history of COVID-19 and those without a history of COVID-19. Non-Hispanic Black patients had the highest VTE prevalence, 6.14% among those with a history of COVID-19 and 3.89% among those without a history of Covid-19, as compared to other race/ethnicity groups. Both Non-Hispanic White and non-Hispanic Black patients with a history of COVID-19 had >50% increased risk of VTE than those without a history of COVID-19 (Adjusted PR, 1.59, 95% CI, 1.42-1.78 for Non-Hispanic White, 1.58, 95% CI, 1.28-1.94 for Non-Hispanic Black, p<0.001). Conclusion: AIS patients with a history of COVID-19 had an increased risk of VTE compared with patients without COVID-19. Healthcare professionals should be aware of the increased risks of VTE among AIS patients with COVID-19 and implement protocols for early VTE prevention.

8.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724015

ABSTRACT

Objectives: Evidence suggests an association of increased cerebrovascular accidents frequency in patients diagnosed with the novel coronavirus disease, COVID-19. Coagulopathy resulting from the 2019 novel coronavirus (SARS-CoV-2) infection is suspected. This study aims at evaluating thrombotic markers in relation to stroke severity and functional outcomes in a patient cohort of acute ischemic stroke (AIS) with concurrent COVID-19. Methods: We performed a retrospective observational cohort study of 28 patients who tested positive for SARS-CoV-2 via polymerase chain reaction and concomitant AIS confirmed by brain imaging. We analyzed data regarding initial stroke presentation, markers of coagulopathy, and 90- day functional outcomes. Results: The patient cohort displayed high rate of comorbidities with 78.6% having at least 1 vascular risk factor. NIHSS had a median of 16 at initial presentation and median stroke volume of 52 mL. Median NIHSS at discharge or prior to death was 19, and median 90-day mRS was 4. Highest fibrinogen level recorded showed a median of 759.54 mg/dL (IQR 653.75-940.75), D-dimer and lactate dehydrogenase (LDH) showed a median highest recorded value 24,106 ng/mL (IQR 6105.00-80165.00) and 442 ng/mL (IQR 277.00-545.50), respectively. LDH (p=0.0008), D-dimer (p=0.001), and maximum fibrinogen levels (p=0.049) near the time of stroke significantly predicted final NIHSS and functional outcome 90-days after discharge. Conclusions: Adult patients with acute ischemic stroke and concurrent COVID-19 disease exhibited abnormally high markers of coagulopathy, and LDH, D-Dimer, and fibrinogen levels were predictors of morbidity and neurological disability at 90-days in this patient population. Further research is necessary to establish a definitive pattern and assess the ability to use these markers as prognostic elements of 90-day functional outcome.

9.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724014

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is a viral disease that has primarily been known to cause respiratory symptoms;however, there has also been an association of COVID-19 with neurological symptoms, including acute ischemic stroke (AIS). There is a lack of data on the characteristics of AIS patients with COVID-19 from the stroke belt. We aim to describe the characteristics of patients with COVID-19 and AIS and compare the characteristics of those who required intensive care unit (ICU) admission versus ward-only. Methods: Single center, retrospective cohort study of adult patients admitted in a tertiary academic center from March 1-December 31, 2020. The institutional COVID database was utilized for data collection. Demographic, clinical and laboratory data were collected. Primary outcome measure was mortality. Secondary outcomes included hospital length of stay (LOS) and discharge disposition. Results: Both COVID-19 and AIS were found in 2.4% (n=75) of patients out of 3,031 patients with COVID-19, during the study period. These patients were male (45, 60%), African American (43, 57%), 65±12 years old, with hypertension (69, 92%) and Diabetes Mellitus type 2 (50, 67%). We noted a 20% (n=15) overall in-patient mortality rate among patients with both COVID-19 and AIS. Among these patients, 23% (n=17) required ICU admission. Demographic, clinical and laboratory characteristics were comparable among ICU versus ward-only patients except for higher LDH (476.12±189.70 vs 276.17±88.35 U/L, p==0.0003);and lower relative lymphocytic count (3.57±3.56 vs 8.93±7.83 10 cells/μL, p=0.0160) among those admitted into the ICU. Mortality (13, 68% vs 6, 32%, p<0.001) was significantly higher among the ICU cohort while majority of the ward-only cohort were discharged home (21, 95%). Conclusion: We present the first description of characteristics and outcomes of patients with AIS and COVID-19 from Mississippi. Novel to this cohort is the comparison of those who were admitted into the ICU versus ward-only. Prospective studies analyzing larger datasets of COVID-19 and stroke in the stroke-belt are warranted to further study disparities of care and outcomes.

10.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724013

ABSTRACT

Background: COVID-19 is thought to induce a pro-thrombotic state, which might increase stroke risk. The purpose of this project is to assess stroke severity, type and coagulation markers such as D-dimer, fibrinogen, and CRP in patients with acute ischemic stroke (AIS) and COVID-19, compared to a control group of AIS without COVID-19. Methods: We captured discharge diagnosis of all patients at our medical center with AIS and COVID based on their discharge ICD-10 coding between June 2020 and May 2021;and identified AIS without COVID matched for age, sex, race, and ethnicity. Group 1 was AIS with COVID-19, Group 2 matched (3:1) AIS without COVID-19. We compared baseline demographics, NIHSS, Ddimer, fibrinogen, CRP, presence of large vessel occlusion (LVO) in COVID-19 AIS vs non-COVID19 AIS. We used a T test to compare parametric and Mann Whitney U for non-parametric values. Results: In total 23 (of 397 total AIS) patients were in Group 1;69 in Group 2. D-dimer levels (mean) were 3237.3 in Group 1, and 2706.8 in Group 2 (NS), Fibrinogen 464.4 and 379.8 (NS), CRP 7.9 and 9.4 (NS). Median NIHSS was 21 versus 5 (p=0.003). LVO was present in 17 patients in Group 1 (73%) and 23 (33%) in Group 2 (NS). In total, only 5.8% (23 of 397) of all AIS in our data had Covid-19 infection. Conclusion: COVID in stroke was an infrequent finding in our sample (5.8%). Patients with COVID and stroke had higher initial stroke severity, but did not differ in coagulation values. Weather coagulation markers can help distinguish patients with COVID related stroke will require subsequent studies. We need additional data before treatment recommendations specific to stroke in COVID can be made.

11.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1724006

ABSTRACT

Background and Purpose: We sought to investigate the impact of COVID-19 pandemic on number of acute stroke patients admitted to Japanese primary stroke centers (PSCs). Methods: The Japan Stroke Society and the MHLW registry of mechanical thrombectomy for acute ischemic stroke conducted a national annual survey of hospitalization volumes for acute ischemic stroke, intracranial cerebral hemorrhage, and subarachnoid hemorrhage in PSCs. Number of acute stroke patients was defined as sum of three stroke subtypes admitted within 7 days after the onset. Monthly acute stroke volumes were compared between 2019 and 2020, among COVID-19 waves, and regional infectious rates. Results: The stroke volume data was completed in 530 PSCs. The annual acute stroke volume was declined 2.5% from 179,893 in 2019 to 174,385 in 2020. Number of acute stoke patients was declined during COVID-19 expanding periods (1 wave, Mar-May;2 wave Jul-Aug;3 wave NovDec), whereas it was increased in the other months. The mean decline rate of stroke volumes from 2019 to 2020 was greater in 125 PSCs located in prefectures with high estimated SARS-CoV 2 infected rate (more than 2,300 per million people) than in 405 PSCs of the other regions (-4.6±15.4% vs -0.1±20.0%, P=0.008), especially during COVID-19 expanding periods (-8.2±17.9% vs -3.1±21.3%, P=0.009). Conclusions: Acute stroke volumes were declined in 2020 from 2019 in Japanese PSCs, especially during COVID-19 expanding periods and in highly infected regions. The overwhelmed health care system and infection control practices may have associated with decline of number of acute stroke patients during COVID-19 pandemic.

12.
Stroke ; 53(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1723999

ABSTRACT

Introduction: Findings of association between COVID-19 and stroke remain inconsistent, ranging from significant association, absence of association to less than expected ischemic stroke among hospitalized patients with COVID-19. The present study examined the association between COVID19 and risk of acute ischemic stroke (AIS). Methods: We included 19,553 Medicare fee-for-service (FFS) beneficiaries aged ≥65 years diagnosed with COVID-19 between April 1 and November 30, 2020 and AIS hospitalization from January 1, 2019 through November 30, 2020. We used a self-controlled case series design to examine the association between COVID-19 and AIS and estimated the incident rate ratios (IRR) by comparing incidence of AIS in risk periods (0-3, 4-7, 8-14, 15-28 days after diagnosis of COVID-19) vs. control periods. Results: Among 19,553 Medicare FFS beneficiaries with COVID-19 and AIS, the median age at diagnosis of COVID-19 was 80.5 (interquartile range 73.6-87.3) years and 57.5% were women. IRRs at 0-3, 4-7, 8-14, and 15-28 days following COVID-19 diagnosis were 10.97 (95% confidence interval 10.30-11.68), 1.59 (1.35-1.87), 1.23 (1.07-1.41), and 1.06 (0.95-1.18), respectively. The association appeared to be stronger among younger beneficiaries and among beneficiaries without prior history of stroke but largely consistent across sex and race/ethnicities. Conclusions: Risk of AIS among Medicare FFS beneficiaries was ten times as high during the first 3 days after diagnosis of COVID-19 as during the control period and the risk associated with COVID-19 appeared to be stronger among those aged 65-74 years and those without prior history of stroke.

13.
Biomedicines ; 10(2)2022 Feb 13.
Article in English | MEDLINE | ID: covidwho-1686606

ABSTRACT

(1) Background: COVID-19 infection is responsible for the ongoing pandemic and acute cerebrovascular disease (CVD) has been observed in COVID-19 patients. (2) Methods: We conducted a retrospective, observational study of hospitalized adult patients admitted to our hospital with SARS-CoV-2 and acute cerebrovascular disease. All clinical data were reviewed including epidemiology, clinical features, laboratory data, neuroradiological findings, hospital management and course from 32 patients hospitalized for COVID-19 management with acute cerebrovascular disease. (3) Results: Acute CVD with COVID-19 was associated with higher NIH stroke scale on discharge compared to non-COVID-19 CVDs. Seizures complicated the hospital course in 16% of COVID-19 patients with CVD. The majority of the acute CVDs were ischemic (81%) in nature followed by hemorrhagic (22%). Acute CVD with COVID-19 resulted in average hospital stays greater than twice that of the control group (13 days in COVID-19, 5 days in control). Acute CVD with COVID-19 patients had worse clinical outcomes with 31% patient deaths and 6% discharged to hospice. In the control group, 6% of patients died. (4) Conclusions: Acute CVD associated with COVID-19 tends to be more complicated with unique and adverse clinical phenotype, longer hospital admissions, and worse clinical outcomes.

14.
Neurol Sci ; 2022 Feb 09.
Article in English | MEDLINE | ID: covidwho-1680937

ABSTRACT

BACKGROUND: COVID-19 pandemic directly impacted the request for hospital care and medical assistance for several diseases worldwide, as occurred with acute ischemic stroke. The present study sought to compare the incidence and severity of acute ischemic stroke (AIS), in addition to sociodemographic, clinical, and radiological characteristics of patients hospitalized in the prepandemic (2018-2019) and pandemic (2020-2021) eras. METHODS: An incidence case-control, observational, and analytical research was carried out in the Stroke Unit of Hospital Governador Celso Ramos, Florianopolis, Santa Catarina, Brazil, including 171 patients admitted with acute ischemic stroke from April 2018 to April 2019 (prepandemic era) and 148 patients between January 2020 and January 2021 (during pandemic). RESULTS: The mean incidence of AIS hospital admissions was significantly lower in the pandemic period (CI 95%, 0.2 to 5.6; p = 0.04), being lower in the lockdown periods and when the incidence of new COVID-19 cases increased. Besides, referring to AIS severity, the mean areas of AIS were larger during the pandemic period (p < 0.01), especially in August, September, December, and January (p < 0.05). Sociodemographic and clinical variables did not show any difference between the two periods of the study. CONCLUSIONS: Hospital admissions for AIS decreased in the COVID-19 pandemic, mostly during months of higher incidences of new COVID-19 cases. When the incidence of admissions diminished, an increase in the severity of AIS was observed, characterized by larger areas. These findings might contribute to other similar referral centers in managing public policies related to stroke.

15.
Indian Journal of Critical Care Medicine ; 26(2):235-238, 2022.
Article in English | Scopus | ID: covidwho-1675045

ABSTRACT

Background: COVID-19 infection can be associated with systemic hyper inflammation, hypercoagulable state, vasculitis, and cardiomyopathy leading to multiorgan failure. Use of extracorporeal blood purificationhas been shown to mitigate the cytokine storm, improving hemodynamic stability and pulmonary function. Case summary: We report a case of a young patient with malignant cerebral edema due to acute cerebrovascular accident, with COVID-19. He was taken up for life-saving decompression craniotomy amidst the cytokine storm and multiorgan failure, and was treated with steroids, antibiotics, and cytosorb® therapy for the cytokine storm. IL-6 and PCT levels were reduced by 99.5 and 98.6%, respectively. Vasopressors were stopped on day 4 and successfully weaned off ventilator support by 2 weeks of tracheostomy. He was de-cannulated and discharged neurologically stable on day 32. Conclusion: Timely detection of COVID-19 and anti-inflammatory and hemo-adsorption measures may be helpful in modulating cytokine storm, thereby reducing morbidity and mortality. © The Author(s). 2022 Open Access.

16.
Life (Basel) ; 12(2)2022 Jan 29.
Article in English | MEDLINE | ID: covidwho-1667229

ABSTRACT

Stroke in patients with COVID-19 has received increasing attention throughout the global COVID-19 pandemic, perhaps due to the substantial disability and mortality that can result when the two conditions co-occur. We reviewed the existing literature and found that the proposed pathomechanism underlying COVID-19-associated ischemic stroke is broadly divided into the following three categories: vasculitis, endothelialitis, and endothelial dysfunction; hypercoagulable state; and cardioembolism secondary to cardiac dysfunction. There has been substantial debate as to whether there is a causal link between stroke and COVID-19. However, the distinct phenotype of COVID-19-associated strokes, with multivessel territory infarcts, higher proportion of large vessel occlusions, and cryptogenic stroke mechanism, that emerged in pooled analytic comparisons with non-COVID-19 strokes is compelling. Further, in this article, we review the various treatment approaches that have emerged as they relate to the proposed pathomechanisms. Finally, we briefly cover the logistical challenges, such as delays in treatment, faced by providers and health systems; the innovative approaches utilized, including the role of tele-stroke; and the future directions in COVID-19-associated stroke research and healthcare delivery.

17.
Neurol Sci ; 43(4): 2211-2215, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1640873

ABSTRACT

We sought to analyze the effect of COVID-19 on telestroke requests and to characterize patients remotely evaluated for acute ischemic stroke (AIS) during this time. This study is a retrospective database review of all telestroke requests at one academic vascular neurology center telestroke network with seven remote sites in the USA between March 15 and April 30, 2020. Data were compared with historical cohort spanning same time frame in 2019 using parametric or nonparametric methods as appropriate. Among telestroke requests, characteristics of age, gender, race/ethnicity, National Institutes of Health Stroke Scale (NIHSS), primary diagnosis of AIS or transient ischemic attack (TIA), and number of patients receiving intravenous alteplase (IV-rtPA) and endovascular therapy (ET) were recorded. There was a 53% decrease in telestroke evaluation requests in 2020 from 2019 (p < 0.00001). Mean NIHSS in 2020 was 9.1 (SD ± 8.4) and mean NIHSS in 2019 was 7.2 (SD ± 7.3) (p = 0.122). Among patients with primary diagnosis of suspected AIS or TIA, mean age was 60.5 years in 2020 (SD ± 17.5) and mean age of 67.0 years in 2019 (SD ± 16.0) (p = 0.038). A significant lower number of telestroke evaluations were performed with a higher mean NIHSS overall and a lower mean age among AIS/TIA-suspected patients. Higher NIHSS and severity in all telestroke evaluations reflect neurological manifestations of AIS and mimics, possibly influenced by COVID-19. The younger age of those with suspected AIS or TIA reflects thrombotic complications in atypical stroke populations.


Subject(s)
COVID-19 , Ischemic Stroke , Stroke , Aged , Fibrinolytic Agents/therapeutic use , Humans , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/drug therapy , Stroke/therapy
18.
Bahrain Medical Bulletin ; 43(4):761-765, 2021.
Article in English | EMBASE | ID: covidwho-1628246

ABSTRACT

Objectives: We aim to highlight the relationship between COVID-19 and stroke even after anticoagulants administration to our reported patients. Methods: Retrospective data were obtained from the Bahrain Defense Force (BDF) hospital medical records. This paper presents six male patients who were diagnosed with COVID-19 cases based on the polymerase chain reaction (PCR) nasopharyngeal swab test. They were admitted into the field intensive care unit of BDF Hospital. Those patients received therapeutic doses of anticoagulants during their hospitalizations. They developed new onset of neurological deficits. Radiological imaging was done to confirm the diagnosis of stroke. Patient information was kept private. Results: Based on the clinical presentation followed by radiological examination, five patients were diagnosed with acute ischemic stroke and one with intracerebral hemorrhage despite the administration of therapeutic doses of anticoagulants which indicated the significant relationship between COVID-19 and stroke. Conclusion: There is a significant relationship between COVID-19 and stroke which is highlighted in this study. COVID-19 is considered a risk factor of stroke regardless the use of therapeutic dose of anticoagulants. In addition, the study shows that the risk of COVID-19 related stroke increases in male patients with comorbidities.

19.
Journal of the Pakistan Medical Association ; 71(12):S157-S160, 2021.
Article in English | Web of Science | ID: covidwho-1619112

ABSTRACT

Covid-19 is associated with different neurological manifestations. About one third of Covid-19 patients have some neurological disorders as paresthesia, headache, cold extremities and disturbances of consciousness, which are more evident in severely affected patients. These neurological manifestations may coexist or precede the onset of respiratory manifestations by about 2-3 weeks. Acute ischaemic stroke (AIS) and associated brain damage may develop due to acute respiratory distress syndrome (ARDS) induced-hypoxia. Prolonged hypoxia in late-stage Covid-19 leads to vasodilatation, intracranial hypertension, brain oedema, and AIS. In view of substantial evidence, this perspective explores the potentially direct or indirect effect of SARS-CoV-2 on the Central Nervous System of patients with COVID-19 pneumonia. The AIS is the end of most Covid-19-induced neurological complications. Covid-19 can lead to various neurological manifestations due to involvement of CNS directly through olfactory neurons or indirectly through induction of cytokine storm.

20.
Blood ; 138:2903, 2021.
Article in English | EMBASE | ID: covidwho-1582346

ABSTRACT

Four decades ago, Hal Broxmeyer demonstrated that umbilical cord blood (CB) contained hematopoietic stem cells (HSC) and hypothesized that CB could be used as a source of donor HSC for rescue of myeloablated bone marrow. In 1988, Gluckman et al reported the first successful cord blood transplant (CBT) of a child with Fanconi Anemia using matched sibling CB. This patient survives and 35 years later still has durable hematopoiesis from the CB donor graft. In 1991, Rubinstein et al established an unrelated donor (UD) CB bank and in 1993 the first UD CBT was using a unit from this bank. Since that time, >40,000 CBTs have been performed worldwide. We hypothesized that changes in cord blood banking (increased size, diversity, and quality of banked units enabling selection of units with higher cell doses and closer HLA matching) and in transplantation (less use of steroids, availability of newer therapies for prophylaxis and treatment of graft versus host disease [GVHD], improved antifungal and antiviral detection and therapeutics) have improved outcomes of CBT today. To address this hypothesis, we performed a retrospective study combining data from Eurocord and Duke University in a large cohort of children transplanted with a single UD CB unit (CBU) from 1993-2019. Standard transplant outcomes (overall survival [OS], disease free survival [DFS], acute and chronic GVHD, treatment related mortality [TRM], and relapse) and changes in outcomes over 3 time periods (1:<2005, n=1297;2:2005-2010, n=1735;and 3:>2010, n=1802) were studied. Relative contributions of cell dose and HLA matching to transplant outcomes over time were assessed. A total of 4834 patients (4015 from Eurocord and 819 from Duke) were analyzed. The majority of patients, (59%, n=2839) had malignant diagnoses including 1422 with ALL, 887 with AML and 167 with MDS. Of the 1995 with non-malignant diagnoses, 761 had inborn errors of metabolism, 644 had primary immunodeficiency, 325 had a bone marrow failure syndrome and 206 had a histiocytic disorder. Half of the patients had positive serologies for CMV prior to transplant. The median age of the cohort fell from 5.2 to 3.25 years over time. In patients with malignancies, use of total body irradiation decreased over time. The median total nucleated cell (TNC) and CD34+ cell doses administered were 8.07x10e7 and 6.17x10e5 cells/kg and increased over time. HLA matching and transplantation of patients in earlier disease states also increased over time, p<0.001 for both. The probability of 5-year OS in the entire cohort was 53.48% and improved over time: 42%;57.4%;and 60.4%, in periods 1,2,3 respectively (p<0.0001). OS improved with closer HLA matching, higher cell dose, myeloablative conditioning, and negative pre-transplant CMV serologies. For patients with malignancies, DFS increased and TRM and acute GVHD decreased over time. In contrast, leukemic relapse did not change throughout the years. OS was higher in patients with inborn errors of metabolism and also improved over time with 57.8% surviving before 2005, 69.4% from 2005-2010, and 71% after 2010 (p=0.0141). Similar results were seen in the cohort with immune deficiencies. In the entire cohort, the median time to neutrophil engraftment decreased from 25 days (period 1) to 19 days (period 3). In multivariate analysis for engraftment, a higher TNC dose (p=0.001) up to but not beyond the median cell dose (8.07x10e7 cells/kg), total body irradiation, and the use of ATG improved engraftment. Acute GVHD decreased from 35% before 2005 to 27.1% after 2010 (p=0.0556) while the incidence of chronic GvHD was stable. The use of ATG reduced the risk of acute GVHD and closer HLA matching reduced the risk of both acute and chronic GVHD. In this population of patients receiving high cell doses, outcomes were predominantly influenced by HLA matching and increasing cell dose did not abrogate HLA mismatching. In conclusion, we analyzed the largest cohort of pediatric patients undergoing CBT over the past 3 decades. OS, DFS and engraftment have improved over time accompanied b decreases in TRM and acute GVHD. Relapse and chronic GVHD were stable and remain low. These improvements are explained by the increased availability of high quality banked CBUs enabling selection of closer HLA matching and units with higher cell doses. The numbers of CBTs have decreased in the past decade, but these results support the ongoing use of CBT in children lacking matched related or unrelated donors. [Formula presented] Disclosures: Kurtzberg: Neurogene: Consultancy;CryoCell: Patents & Royalties: Duke licensed IP, and data and regulatory packages for manufacturing and use of cord blood and cord tissue MSCs in the treatment of patients with hypoxic ischemic encephalopathy, cerebral palsy, autism, acute ischemic stroke, COVID-ARDS, and COVID-MIS-C.;Sinocell: Patents & Royalties: Duke licensed IP, data, and regulatory packages for use of autologous and sibling cord blood to treat children with cerebral palsy.;Celularity: Current holder of stock options in a privately-held company. Troy: SinoCell: Patents & Royalties;CryoCell: Patents & Royalties;Bristol Myers Squibb: Research Funding;Synthetic Biologics: Honoraria;Gamida Cell: Consultancy;The EMMES Corporation: Consultancy;The Community Data Roundtable: Consultancy;AegisCN: Consultancy.

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