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1.
BMC Emerg Med ; 22(1): 136, 2022 07 26.
Article in English | MEDLINE | ID: covidwho-1962739

ABSTRACT

OBJECTIVE: We aimed to evaluate door-to-puncture time (DPT) and door-to-recanalization time (DRT) without directing healthcare by neuro-interventionalist support in the emergency department (ED) by workflow optimization and improving patients' outcomes. METHODS: Records of 98 consecutive ischemic stroke patients who had undergone endovascular therapy (EVT) between 2018 to 2021 were retrospectively reviewed in a single-center study. Patients were divided into three groups: pre-intervention (2018-2019), interim-intervention (2020), and post-intervention (January 1st 2021 to August 16th, 2021). We compared door-to-puncture time, door-to-recanalization time (DRT), puncture-to-recanalization time (PRT), last known normal time to-puncture time (LKNPT), and patient outcomes (measured by 3 months modified Rankin Scale) between three groups using descriptive statistics. RESULTS: Our findings indicate that process optimization measures could shorten DPT, DRT, PRT, and LKNPT. Median LKNPT was shortened by 70 min from 325 to 255 min(P < 0.05), and DPT was shortened by 119 min from 237 to 118 min. DRT shortened by 132 min from 338 to 206 min, and PRT shortened by 33 min from 92 to 59 min from the pre-intervention to post-intervention groups (all P < 0.05). Only 21.4% of patients had a favorable outcome in the pre-intervention group as compared to 55.6% in the interventional group (P= 0.026). CONCLUSION: This study demonstrated that multidisciplinary cooperation was associated with shortened DPT, DRT, PRT, and LKNPT despite challenges posed to the healthcare system such as the COVID-19 pandemic. These practice paradigms may be transported to other stroke centers and healthcare providers to improve endovascular time metrics and patient outcomes.


Subject(s)
COVID-19 , Ischemic Stroke , Stroke , Humans , Ischemic Stroke/surgery , Pandemics , Punctures , Retrospective Studies , Stroke/therapy , Thrombectomy , Time-to-Treatment , Treatment Outcome , Workflow
2.
Stroke ; 53(8): 2497-2503, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1962530

ABSTRACT

BACKGROUND: Data from the early pandemic revealed that 0.62% of children hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had an acute arterial ischemic stroke (AIS). In a larger cohort from June 2020 to December 2020, we sought to determine whether our initial point estimate was stable as the pandemic continued and to understand radiographic and laboratory data that may clarify mechanisms of pediatric AIS in the setting of SARS-CoV-2. METHODS: We surveyed international sites with pediatric stroke expertise to determine numbers of hospitalized SARS-CoV-2 patients <18 years, numbers of incident AIS cases among children (29 days to <18 years), frequency of SARS-CoV-2 testing for children with AIS, and numbers of childhood AIS cases positive for SARS-CoV-2 June 1 to December 31, 2020. Two stroke neurologists with 1 neuroradiologist determined whether SARS-CoV-2 was the main stroke risk factor, contributory, or incidental. RESULTS: Sixty-one centers from 21 countries provided AIS data. Forty-eight centers (78.7%) provided SARS-CoV-2 hospitalization data. SARS-CoV-2 testing was performed in 335/373 acute AIS cases (89.8%) compared with 99/166 (59.6%) in March to May 2020, P<0.0001. Twenty-three of 335 AIS cases tested (6.9%) were positive for SARS-CoV-2 compared with 6/99 tested (6.1%) in March to May 2020, P=0.78. Of the 22 of 23 AIS cases with SARS-CoV-2 in whom we could collect additional data, SARS-CoV-2 was the main stroke risk factor in 6 (3 with arteritis/vasculitis, 3 with focal cerebral arteriopathy), a contributory factor in 13, and incidental in 3. Elevated inflammatory markers were common, occurring in 17 (77.3%). From centers with SARS-CoV-2 hospitalization data, of 7231 pediatric patients hospitalized with SARS-CoV-2, 23 had AIS (0.32%) compared with 6/971 (0.62%) from March to May 2020, P=0.14. CONCLUSIONS: The risk of AIS among children hospitalized with SARS-CoV-2 appeared stable compared with our earlier estimate. Among children in whom SARS-CoV-2 was considered the main stroke risk factor, inflammatory arteriopathies were the stroke mechanism.


Subject(s)
COVID-19 , Ischemic Stroke , Stroke , COVID-19/epidemiology , COVID-19 Testing , Child , Humans , Ischemic Stroke/epidemiology , Pandemics , Prevalence , SARS-CoV-2 , Stroke/epidemiology , Stroke/etiology
3.
Acta Neurol Belg ; 2022 Jul 25.
Article in English | MEDLINE | ID: covidwho-1959182

ABSTRACT

INTRODUCTION: Stroke-associated pneumonia (SAP) is a significant cause of morbidity and mortality after stroke. Various factors, including dysphagia and stroke severity, are closely related to SAP risk; however, the contribution of the baseline pulmonary parenchymal status to this interplay is an understudied field. Herein, we evaluated the prognostic performance of admission chest computed tomography (CT) findings in predicting SAP. METHODS: We evaluated admission chest CT images, acquired as part of a COVID-19-related institutional policy, in a consecutive series of acute ischemic stroke patients. The pulmonary opacity load at baseline was quantified using automated volumetry and visual scoring algorithms. The relationship between pulmonary opacities with risk of pneumonia within 7 days of symptom onset (i.e., SAP) was evaluated by bivariate and multivariate analyses. RESULTS: Twenty-three percent of patients in our cohort (n = 100) were diagnosed with SAP. Patients with SAP were more likely to have atrial fibrillation, COPD, severe neurological deficits, and dysphagia. The visual opacity score on chest CT was significantly higher among patients who developed SAP (p = 0.014), while no such relationship was observed in terms of absolute or relative opacity volume. In multivariate analyses, admission stroke severity, presence of dysphagia and a visual opacity score of ≥ 3 (OR 6.37, 95% CI 1.61-25.16; p = 0.008) remained significantly associated with SAP risk. CONCLUSIONS: Pulmonary opacity burden, as evaluated on admission chest CT, is significantly associated with development of pneumonia within initial days of stroke. This association is independent of other well-known predisposing factors for SAP, including age, stroke severity, and presence of dysphagia.

4.
American Journal of Neurodegenerative Diseases ; 11(2):34-45, 2022.
Article in English | EMBASE | ID: covidwho-1955718

ABSTRACT

Complications are increasingly recognized with SARS-CoV-2, the causative pathogen for COVID-19. Various mechanisms have been proposed to justify the cause of seizures in Covid-19 patients. To our knowledge, 13 cases of status epilepticus (SE) associated with COVID-19 have been reported so far. Here, we present a single-center case series, including the clinical, laboratory, and imaging characteristics, and the EEG and the outcome of SE in 5 Iranian patients with laboratory-confirmed SARS-CoV-2 virus. SE was para-infectious in four patients and post-infectious in one other patient. In Three patients, the causes of seizure were included severe hyponatremia, acute ischemic stroke, and meningoencephalitis. However, in two other patients, no specific reason for seizure was found, but there are possibilities for lesser-known mechanisms of Covid-19 that play roles in developing SE. Two of the patients recovered, and three patients, older and with higher comorbidities, failed to recover and died.

5.
J Stroke Cerebrovasc Dis ; 31(8): 106522, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1956243

ABSTRACT

OBJECTIVES: Transient ischemic attack (TIA) serves a precursor for an acute ischemic stroke (AIS); however, not all TIA patients harbor the same risk for subsequent AIS. We aimed to investigate expediting outpatient management of low-risk TIA patients (ABCD: Giles and Rothwell, 2007 score ≤ 3) via our "Fast-Track" TIA Protocol (FTTP). MATERIALS AND METHODS: A retrospective analysis was performed on patients who presented to our academic network 04/2020 - 2/2021. Patients who presented with ABCD: Giles and Rothwell, 2007 scores ≤ 3 without large vessel occlusion or flow limiting stenosis were eligible for the FTTP. These patients were discharged on dual antiplatelet therapy and statin and received prescriptions for transthoracic echo, holter monitor, LDL, and A1c along with a scheduled follow-up appointment 30 days from presentation. RESULTS: 182 consecutive patients were evaluated during this period, 21 (11%) were excluded from analysis due to NIHSS > 0 and/or infarct present on MRI. 35 (22%) patients qualified for FTTP and were directly discharged from the ED. Median ABCD2 score was 2 for the discharge group and 4 for the admitted group. There was a significant difference with respect to age and hypertension. Additionally, the FTTP patient population were more likely to be smokers than the admitted patient population. 3 FTTP patients re-presented to the ED, but none of them suffered a symptomatic stroke. CONCLUSIONS: A FTTP demonstrated feasibility and safety with low rates of re-presentation and ischemic stroke. Further research is warranted to determine an optimal patient population that can be safely managed in an outpatient setting.


Subject(s)
Ischemic Attack, Transient , Ischemic Stroke , Stroke , Hospitalization , Humans , Ischemic Attack, Transient/diagnostic imaging , Ischemic Attack, Transient/therapy , Retrospective Studies , Risk Factors , Stroke/diagnostic imaging , Stroke/drug therapy
6.
Journal of Neurocritical Care ; 15(1):65-68, 2022.
Article in English | Scopus | ID: covidwho-1955222

ABSTRACT

Background: Ischemic stroke is one of the serious neurological complications of coronavirus disease 2019 (COVID-19). However, ischemic stroke can develop secondary complications after cardiac involvement in COVID-19. Case Report: We report the case of a 22-year-old patient who presented with malignant cerebral infarction 10 months after COVID-19-related myocarditis. A 22-year-old woman was referred to the emergency room because of abnormal mental status changes. She developed heart failure and arrhythmia after COVID-19-related myocarditis. Brain magnetic resonance imaging (MRI) revealed high signal intensity on diffusion-weighted imaging that was indicative of acute cerebral infarction in the left middle cerebral artery (MCA) and left anterior cerebral artery (ACA) territory. In addition, occlusion of both the left MCA and ACA was observed on brain MRI. Craniectomy with therapeutic hypothermia was performed to treat the cerebral edema. Conclusion: This case suggests that caution is needed in survivors with secondary complications after COVID-19. © 2022 The Korean Neurocritical Care Society.

7.
EPMA J ; 13(2): 177-193, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1943338

ABSTRACT

Mitochondria are the "gatekeeper" in a wide range of cellular functions, signaling events, cell homeostasis, proliferation, and apoptosis. Consequently, mitochondrial injury is linked to systemic effects compromising multi-organ functionality. Although mitochondrial stress is common for many pathomechanisms, individual outcomes differ significantly comprising a spectrum of associated pathologies and their severity grade. Consequently, a highly ambitious task in the paradigm shift from reactive to predictive, preventive, and personalized medicine (PPPM/3PM) is to distinguish between individual disease predisposition and progression under circumstances, resulting in compromised mitochondrial health followed by mitigating measures tailored to the individualized patient profile. For the successful implementation of PPPM concepts, robust parameters are essential to quantify mitochondrial health sustainability. The current article analyses added value of Mitochondrial Health Index (MHI) and Bioenergetic Health Index (BHI) as potential systems to quantify mitochondrial health relevant for the disease development and its severity grade. Based on the pathomechanisms related to the compromised mitochondrial health and in the context of primary, secondary, and tertiary care, a broad spectrum of conditions can significantly benefit from robust quantification systems using MHI/BHI as a prototype to be further improved. Following health conditions can benefit from that: planned pregnancies (improved outcomes for mother and offspring health), suboptimal health conditions with reversible health damage, suboptimal life-style patterns and metabolic syndrome(s) predisposition, multi-factorial stress conditions, genotoxic environment, ischemic stroke of unclear aetiology, phenotypic predisposition to aggressive cancer subtypes, pathologies associated with premature aging and neuro/degeneration, acute infectious diseases such as COVID-19 pandemics, among others.

8.
Curr Treat Options Neurol ; 24(4): 155-171, 2022.
Article in English | MEDLINE | ID: covidwho-1942966

ABSTRACT

Purpose of Review: To describe a comprehensive review of the epidemiology, pathophysiology, and treatment of stroke in the era of COVID-19. Recent Findings: COVID-19 is associated with myriad neurological disorders, including cerebrovascular disease. While ischemic stroke is the most common, COVID-19 is associated with an increased risk of intracranial hemorrhage, arterial dissection, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis. In this review, we discuss the epidemiology, pathophysiology, and treatment of stroke due to COVID-19. In addition, we describe how COVID-19 has changed the landscape of stroke systems of care and the effect this has had on patients with cerebrovascular disease. Summary: While COVID-19 is associated with a heightened risk of stroke, the pandemic has led to advances in stroke systems of care that may reduce the long-term burden of stroke.

9.
J Thromb Thrombolysis ; 53(4): 824-828, 2022 May.
Article in English | MEDLINE | ID: covidwho-1942573

ABSTRACT

Understanding the relationship of COVID-19 to stroke is important. We compare characteristics of pre-pandemic stroke (PPS), cases in acute COVID infection (CS) and in patients who have recovered from COVID-19 infection (RCS). We interrogated the Qatar stroke database for all stroke admissions between Jan 2020 and Feb 2021 (PPS) to CS and RCS to determine how COVID-19 affected ischemic stroke sub-types, clinical course, and outcomes prior to, during and post-pandemic peak. There were 3264 cases admitted (pre-pandemic: 3111, stroke in COVID-19: 60 and recovered COVID-19 stroke: 93). Patients with CS were significantly younger, had more severe symptoms, fever on presentation, more ICU admissions and poor stroke recovery at discharge when compared to PPS and RCS. Large vessel disease and cardioembolic disease was significantly higher in CS compared to PPS or RCS. There was a significant decline in stroke mimics in CS. Stroke in RCS has characteristics similar to PPS with no evidence of lasting effects of the virus on the short-term. However, CS is a more serious disease and tends to be more severe and have a poor prognosis.


Subject(s)
COVID-19 , Ischemic Stroke , Stroke , COVID-19/epidemiology , Humans , Ischemic Stroke/diagnosis , Ischemic Stroke/epidemiology , Pandemics , Qatar/epidemiology , Stroke/diagnosis , Stroke/epidemiology
10.
Journal of Hypertension ; 40:e179, 2022.
Article in English | EMBASE | ID: covidwho-1937739

ABSTRACT

Objective: The objective of the study was to estimate how the proinflammatory and prothrombotic imbalances correlates with cardiovascular and renal events at hypertensive patients (pts) after Covid-19. Design and method: 40 hypertensive pts, (mean age 58.5 ± 9.6 years, 52.5% males)=group 1 and 40 hypertensive pts recovered after Covid-19, matched for age and sex (mean age 60.4 ± 10.8 years, 55% males)=group 2. Inflammation profile was estimated by serum measurement of C reactive protein (CRP), ferritin (F), interleukin 6 (IL6) and fibrinogen (Fb). Prothrombotic profile was determined by serum measurement of D-Dimer (DD). All pts were evaluated during one year, in order to detect the following complications: unstable angina (UA), non-STsegment elevation myocardial infarction (NSTEMI), ischemic stroke (IS), renal dysfunction (RD): microalbuminuria, proteinuria, chronic kidney disease. Results: In group 1, UA was significantly associated with higher level of CRP (2.25 ± 0.65 mg/L vs 7.32 ± 1.18 mg/L, p = 0.04). In the same group, RD was found in a higher proportion at pts with increased CRP (2.10 ± 0.56 mg/L vs 8.11 ± 1.21 mg/L, p = 0.02). In group 2, UA was also significantly associated with higher level of CRP (3.44 ± 0.62 mg/L vs 9.68 ± 1.15 mg/L, p = 0.03) and with greater proportion of DD (0.35 ± 0.08 mcg/ml vs 1.53 ± 0.12 mcg/ml, p = 0.01). NSTEMI was found in a higher proportion at pts with increased DD (0.42 ± 0.07 mcg/ml vs 1.87 ± 0.15 mcg/ml, p = 0.01). In the same group, RD was significantly more frequent at pts with higher level of IL6 (4.55 ± 0.92 pg/ml vs 8.32 ± 0.85 pg/ml, p = 0.04) and with greater level of F (76 ± 15 ng/ml vs 635 ± 26 ng/ml, p = 0.01). Conclusions: Proinflammatory status seems to predict a worse midterm outcome (one year) concerning cardiovascular and renal events at hypertensive pts, especially after Covid-19. Moreover, proinflammatory and prothrombotic imbalances appears to have more powerful midterm prognostic value for incidence of acute coronary syndromes without ST-segment elevation and for incidence of RD at hypertensive pts recovered after Covid-19.

11.
Journal of Hypertension ; 40:e148, 2022.
Article in English | EMBASE | ID: covidwho-1937701

ABSTRACT

Objective: The purpose is to identify the peculiarities of the parameters of red blood cells (RBC) and hemostasis in patients with strokes associated with coronavirus infection. Design and method: A total of 124 patients (48.5 + 1.9 years) with impairments of cerebral circulation due to COVID-19 (confirmed by positive PCR test) had been examined. Among them, 74 patients had ischemic stroke, 25- transient ischaemic attack, 17- intracerebral hemorrhage, 8- subarachnoid hemorrhage. The parameters of hemostasis were measured by standard methods, electrical, viscoelastic parameters of RBC - by dielectrophoresis. Results: 71 patients (the 1st group) showed signs of intravascular coagulation and thrombosis: accelerated platelet-leukocyte aggregation, increased levels of coagulation products, reduced fibrinolysis activity (p = 0.001-0.04). The levels of D-dimer, fibrinogen, ESR, platelet count were higher in this group compared to the second one (p < 0.01). A moderate increase of RBC summarized rigidity, viscosity was noted. The level of RBC hemolysis was associated with platelet count (r = 0.735,p = 0.03), D-dimer (r = 0.482, p < 0.05), fibrinogen level (r = 0.374, p = 0.04). In 2nd group (53 persons), the markers of thrombosis had moderate deviations. Sharply reduced RBC deformability with increased summarized rigidity, viscosity was dominant coupled with the background of high electrical conductivity of cell membranes compared to the indicators in the 1st group (p < 0.01). There was a decrease of membrane capacity, surface charge, cell dipole moment, polarizability than those in the 1st group (p = 0.0001-0.05). A sharp decrease of RBC deformability creates obstacles to overcoming small-diameter capillaries, leading to violations of microcirculatory blood flow. RBC deformability was associated with levels of ferritin (r = 0.451, p = 0.02), HbA1c (r = 0.480, p = 0.03), uric acid (r = -0.371, p < 0.05), LDL cholesterol (r = 0.461, p = 0.02). Incubation of blood samples in vitro for 10 min with riboflavin, nicotinamide, inosine, which ensures RBC energy metabolism, restored the reduced RBC deformability (p < 0.01), altered cell morphology (p = 0.04), decreased RBC aggregation (p < 0.001). Conclusions: The revealed features of parameters of RBC hemostasis in stroke patients with coronavirus infection are associated with two independent pathogenetic mechanisms: thrombotic and hemorheologic. The thrombotic variant is due to procoagulant state and an activity of inflammation. The hemorheologic variant is caused by decrease of RBC energy metabolism, activity of enzymes.

12.
Life (Basel) ; 12(7)2022 Jul 17.
Article in English | MEDLINE | ID: covidwho-1938888

ABSTRACT

COVID-19 has affected the entire world and has had a great impact on healthcare, influencing the treatment of patients with acute ischemic stroke (AIS). The aim of this study was to determine the impact of the COVID-19 pandemic on the care of patients with AIS. We performed a retrospective analysis of 1599 patients diagnosed with AIS and hospitalized in the authors' institution from January 2018 to December 2021. The final sample consisted of 265 patients treated with thrombolysis without a diagnosis of COVID-19. The initiation of thrombolytic treatment during the pandemic was delayed (2:42 ± 0:51 vs. 2:25 ± 0:53; p = 0.0006). The delay was mainly related to the pre-hospital phase (1:41 ± 0:48 vs. 1:26 ± 0:49; p = 0.0014), and the door-to-needle time was not affected. There were no differences in stroke severity and patients' outcomes. Patients with AIS were less likely to have previously been diagnosed with atrial fibrillation (16.9% vs. 26.7%; p = 0.0383), ischemic heart disease (25.3% vs. 46.5%; p = 0.0003) and hyperlipidemia (31.2% vs. 46.5%; p = 0.0264). Patients treated during the pandemic had higher glycemia (149.45 ± 54. vs. 143.25 ± 60.71 mg/dL; p= 0.0012), while no significant differences in their lipid profiles were found. Conclusions: The COVID-19 pandemic affected the treatment of AIS patients locally at our stroke center. It caused treatment delay and hindered the recognition of risk factors prior to the occurrence of AIS.

13.
Front Neurol ; 13: 904796, 2022.
Article in English | MEDLINE | ID: covidwho-1933728

ABSTRACT

Introduction: COVID-19 might affect the incidence of specific neurological diseases, but it is unknown if this differs from the risk following other infections. Here, we characterized the frequency of neurodegenerative, cerebrovascular, and immune-mediated neurological diseases after COVID-19 compared to individuals without COVID-19 and those with other respiratory tract infections. Methods: This population-based cohort study utilized electronic health records covering ~50% of Denmark's population (n = 2,972,192). Between 02/2020 and 11/2021, we included individuals tested for COVID-19 or diagnosed with community-acquired bacterial pneumonia in hospital-based facilities. Additionally, we included individuals tested for influenza in the corresponding pre-pandemic period between 02/ 2018 and 11/2019. We stratified cohorts for in- and outpatient status, age, sex, and comorbidities. Results: In total, 919,731 individuals were tested for COVID-19, of whom 43,375 tested positive (35,362 outpatients, 8,013 inpatients). Compared to COVID-negative outpatients, COVID-19 positive outpatients had an increased RR of Alzheimer's disease (RR = 3.5; 95%CI: 2.2-5.5) and Parkinson's disease (RR = 2.6; 95%CI: 1.7-4.0), ischemic stroke (RR = 2.7; 95%CI: 2.3-3.2) and intracerebral hemorrhage (RR = 4.8; 95%CI: 1.8-12.9). However, when comparing to other respiratory tract infections, only the RR for ischemic stroke was increased among inpatients with COVID-19 when comparing to inpatients with influenza (RR = 1.7; 95%CI: 1.2-2.4) and only for those >80 years of age when comparing to inpatients with bacterial pneumonia (RR = 2.7; 95%CI: 1.2-6.2). Frequencies of multiple sclerosis, myasthenia gravis, Guillain-Barré syndrome and narcolepsy did not differ after COVID-19, influenza and bacterial pneumonia. Conclusion: The risk of neurodegenerative and cerebrovascular, but not neuroimmune, disorders was increased among COVID-19 positive outpatients compared to COVID-negative outpatients. However, except for ischemic stroke, most neurological disorders were not more frequent after COVID-19 than after other respiratory infections.

14.
Lipids Health Dis ; 21(1): 15, 2022 Jan 22.
Article in English | MEDLINE | ID: covidwho-1933141

ABSTRACT

BACKGROUND: Bile acids (BAs) not only play an important role in lipid metabolism and atherosclerosis but also have antiapoptotic and neuroprotective effects. However, few studies have focused on the relationship of the total bile acid (TBA) levels with the severity and prognosis of acute ischemic stroke (AIS). OBJECTIVES: The aim of this study was to investigate the potential associations of the fasting serum TBA levels on admission with the stroke severity, in-hospital complication incidence and 3 -month all-cause mortality in patients with AIS. METHODS: A total of 777 consecutive AIS patients were enrolled in this study and were divided into four groups according to the quartiles of the serum TBA levels on admission. Univariate and multivariate logistic regression analyses were used to explore the relationship between the fasting TBA levels and the stroke severity, in-hospital complications, and 3-month mortality in AIS patients. RESULTS: Patients in group Q3 had the lowest risk of severe AIS (NIHSS > 10) regardless of the adjustments for confounders (P < 0.05). During hospitalization, 115 patients (14.8%) had stroke progression (NIHSS score increased by ≥ 2), and 222 patients (28.6%) developed at least one complication, with no significant difference among the four groups (P > 0.05). There was no significant difference in the incidence of pneumonia, urinary tract infection (UTI), hemorrhagic transformation (HT), gastrointestinal bleeding (GIB), seizures or renal insufficiency (RI) among the four groups (P > 0.05). A total of 114 patients (14.7%) died from various causes (including in-hospital deaths) at the 3-month follow-up, including 42 (21.3%), 26 (13.3%), 19 (9.9%) and 27 (13.9%) patients in groups Q1, Q2, Q3 and Q4 respectively, with significant differences (P = 0.013). After adjusting for confounding factors, the risk of death decreased (P -trend < 0.05) in groups Q2, Q3, and Q4 when compared with group Q1, and the OR values were 0.36 (0.16-0.80), 0.30 (0.13-0.70), and 0.29 (0.13-0.65), respectively. CONCLUSIONS: TBA levels were inversely associated with the 3-month mortality of AIS patients but were not significantly associated with the severity of stroke or the incidence of complications.


Subject(s)
Bile Acids and Salts/blood , Ischemic Stroke/mortality , Aged , Female , Humans , Ischemic Stroke/blood , Ischemic Stroke/diagnosis , Male , Middle Aged , Patient Acuity , Prognosis , Risk Factors
15.
J Stroke Cerebrovasc Dis ; 31(8): 106591, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1931013

ABSTRACT

BACKGROUND: Cerebrovascular diseases (CVDs), including varying strokes, can recur in patients upon coronavirus disease 2019 (COVID-19) diagnosis, but risk factor stratification based on stroke subtypes and outcomes is not well studied in large studies using propensity-score matching. We identified risk factors and stroke recurrence based on varying subtypes in patients with a prior CVD and COVID-19. METHODS: We analyzed data from 45 health care organizations and created cohorts based on ICDs for varying stroke subtypes utilizing the TriNetX Analytics Network. We measured the odds ratios and risk differences of hospitalization, ICU/critical care services, intubation, mortality, and stroke recurrence in patients with COVID-19 compared to propensity-score matched cohorts without COVID-19 within 90-days. RESULTS: 22,497 patients with a prior history of CVD within 10 years and COVID-19 diagnosis were identified. All cohorts with a previous CVD diagnosis had an increased risk of hospitalization, ICU, and mortality. Additionally, the data demonstrated that a history of ischemic stroke increased the risk for hemorrhagic stroke and transient ischemic attack (TIA) (OR:1.59, 1.75, p-value: 0.044*, 0.043*), but a history of hemorrhagic stroke was associated with a higher risk for hemorrhagic strokes only (ORs 3.2, 1.7, 1.7 and p-value: 0.001*, 0.028*, 0.001*). History of TIA was not associated with increased risk for subsequent strokes upon COVID-19 infection (all p-values: ≥ 0.05). CONCLUSIONS: COVID-19 was associated with an increased risk for hemorrhagic strokes and TIA among all ischemic stroke patients, an increased risk for hemorrhagic stroke in hemorrhagic stroke patients, and no associated increased risk for any subsequent strokes in TIA patients.


Subject(s)
COVID-19 , Hemorrhagic Stroke , Ischemic Attack, Transient , Ischemic Stroke , Stroke , COVID-19/complications , COVID-19 Testing , Humans , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/etiology , Recurrence , Risk Factors , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapy
16.
Egypt J Neurol Psychiatr Neurosurg ; 58(1): 81, 2022.
Article in English | MEDLINE | ID: covidwho-1928211

ABSTRACT

Background:  Nearly 55 percent of patients are said to be affected by the neurological effects of COVID-19. COVID-19 was shown to be related with stroke in 0.9 to 5% of people. It's critical to assess the impact of COVID-19 on the outcomes of acute ischemic stroke. The goal of this study was to look at the outcomes and characteristics of patients who had an acute ischemic stroke due to covid-19 infection. Results:  The participants in this study were 399 people who had had a stroke. COVID-19 positivity was confirmed in 77 cases, while COVID-19 negativity was confirmed in 322. In the COVID-19 and control groups, the average age of the patients was 65.4 ± 10.2 and 65.3 ± 11.8, respectively. The Covid-19 and control groups had a mean stroke onset of 5.2 ± 2.1 and 5.7 ± 3.8 h, respectively (P = 0.12). There was a high in-hospital mortality rate among patients with COVID-19 with a rate of 11.7% compared to 4.04% among the control group (P = 0.02). At discharge, the number of patients with mRS > 2 was higher (P = 0.001) among the COVID-19. There was a correlation between the mean levels of D-Dimer (r = 0.668, P < 0.001), the severity of COVID-19 (r = 0.802, P < 0.001), and mRS > 2. Conclusion: Despite receiving equal acute care as non-COVID-19 patients, COVID-19 patients had more severe strokes and had worse outcomes. This includes a high chance of death while in the hospital as well as a significant level of disability. Neurologists should use timely and effective therapies, particularly for patients who are at a higher risk of having a stroke. This includes elderly patients, patients with severe COVID-19, patients with high levels of D-Dimer, and those with high NIHSS.

17.
J Cent Nerv Syst Dis ; 14: 11795735221112589, 2022.
Article in English | MEDLINE | ID: covidwho-1928023

ABSTRACT

COVID-19 associated neurological syndromes, including acute ischemic stroke, pose a challenge to treating physicians. The role of MRI in aiding diagnosis and further management is indispensable. The advent of new MRI sequences such as vessel wall imaging (VWI) allows an avenue in which these patients could be better investigated and treated. We describe our experience in managing a patient with COVID-19 associated atherothrombosis and stroke, focusing on the VWI imaging findings.

18.
European Stroke Journal ; 7(1 SUPPL):572, 2022.
Article in English | EMBASE | ID: covidwho-1928145

ABSTRACT

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.

19.
European Stroke Journal ; 7(1 SUPPL):564, 2022.
Article in English | EMBASE | ID: covidwho-1928144

ABSTRACT

Background and aims: Atrial fibrillation (AF) causes at least one-fifth of ischaemic strokes, with a high risk of early recurrence. Oral anticoagulation is highly effective for reducing the long-term risk of recurrent ischaemic stroke in patients with AF. However, its benefit in the acute phase is unclear. OPTIMAS is an RCT aiming to establish the safety and efficacy of early anticoagulation with a direct oral anticoagulant (DOAC). Methods: OPTIMAS will enrol 3,478 participants with ischaemic stroke and AF from 100+ stroke services in the UK. Participants are randomised 1:1 to early (within 4 days) or standard (day 7 to 14 after stroke) initiation of anticoagulation. Follow-up is at 90 days, blinded to treatment allocation. The primary outcome is the incidence of stroke of any cause, and systemic arterial embolism. Results: OPTIMAS opened in June 2019 and is recruiting from 87 sites. 1,714 participants have been randomised. Recruitment and site-set up were reduced during the COVID-19 pandemic, due to national lockdowns and hospital staff being reallocated to COVID-related trials. We rapidly developed a contingency plan to face these challenges, implementing strategies, such as collecting the 90-day follow-ups and obtaining consents over the phone, and encouraging sites to sign up to the NIHR Associate PI Scheme to help with trial-related activities. The trial has consistently been recruiting 80+ patients per month. Conclusions: OPTIMAS will determine the efficacy and safety of early anticoagulation in patients with ischaemic strokes and AF. The trial is recruiting successfully despite COVID-19.

20.
European Stroke Journal ; 7(1 SUPPL):460, 2022.
Article in English | EMBASE | ID: covidwho-1928143

ABSTRACT

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.

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