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1.
Open Access Macedonian Journal of Medical Sciences ; 10(T7):63-67, 2022.
Article in English | EMBASE | ID: covidwho-1818256

ABSTRACT

BACKGROUND: Stroke is known as chronic disease, leading to disability which makes help from caregivers become necessary. Attending stroke patients possess certain challenges and burdens toward the caregivers. AIM: We aim to investigate risk factors related to depression among caregivers attending post-ischemic stroke. METHODS: Eighty-three caregivers and post-ischemic stroke patients were collected consecutively from the Neurology Department of Universitas Sumatera Utara Hospital, Medan, Indonesia. Linear regression was used to analyze the data. RESULTS: Our multivariate study shows that patient’s age, caregiver’s gender, patient’s gender, and modified Barthel Index are associated with depression with adjusted R2 of 59.3%. CONCLUSION: Early detection and intervention should be addressed regularly for caregivers attending post-stroke patients.

2.
Clinical Neurosurgery ; 67(SUPPL 1):129, 2020.
Article in English | EMBASE | ID: covidwho-1816189

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has had a dramatic impact on healthcare systems and a variable disease course. Emerging evidence demonstrates that SARS-CoV-2 is associated with central nervous system (CNS) disease. In this series, we describe CNS manifestations in critical COVID-19 patients at our tertiary academic center. METHODS: A single center retrospective cross-sectional analysis of all patients admitted to our tertiary care academic center inNewOrleans, Louisiana on April 22, 2020, who were in critical condition due to COVID-19 and developed new onset of neurological disease. Patients were grouped into one of three categories according to imaging and clinical features: encephalopathy, acute necrotizing encephalopathy, and vasculopathy. RESULTS: A total of 27 of 76 (35.5%) critical COVID-19 patients met inclusion criteria. Mean age was 59.8 years (range 35-91 years) and most had an underlying medical condition, including hypertension (63%), diabetes mellitus type 2 (52%), obesity (26%), and/or chronic kidney disease (22%). Sixty three percent had evidence of neurological injury on CT, 30% on MRI, 15% on non-invasive vascular imaging, and 44% on EEG. CT findings most often included subacute ischemic strokes, diffuse hypoattenuation, subcortical parenchymal hemorrhages, and focal hypodensities within deep structures. MRI findings included diffuse involvement of deep white matter, the corpus callosum, and the basal ganglia. For patients with acute ischemic stroke, vascular findings consisted of irregular proximal focal stenosis of the supraclinoid internal carotid artery. Twenty patients (74%) were designated with COVID-19 associated encephalopathy, two (7%) with COVID-19 associated acute necrotizing encephalopathy, and five (19%) with COVID-19 associated vasculopathy. CONCLUSION: A one-day snapshot of COVID-19 admissions at a tertiary academic center in New Orleans, LA revealed a high percentage of patients with new neurological disease. Although clinical presentations varied, they were broadly categorized. A better understanding of the neurological sequalae and radiographic findings will help clinicians mitigate the impact of this disease.

3.
Ann Med Surg (Lond) ; 71: 102912, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1814078

ABSTRACT

INTRODUCTION: SARS-COV-2 viral infection primarily targets the respiratory system with a clinical picture that varies from simple symptoms to respiratory distress syndrome requiring hospitalization in the intensive care unit; SARS-CoV-2 also has neuro-invasive capabilities and could spread from the respiratory system to the central nervous system. Recently, some patients with COVID-19 have been shown to have neurological symptoms such as headache, anosmia, dysgeusia, dizziness, impaired consciousness, and ischemic stroke. CASE PRESENTATION: we describe a case of ischemic stroke as the main presentation of COVID-19 in a 68 years old man with no previous history, without any associated respiratory signs; clinical examination revealed left hemiparesis with dysarthria and left facial paralysis, NIHSS score was at 11, the brain CT scan performed 1h30min later, completed by a brain MRI that came back in favor of right frontal, temporal and parietal ischemic stroke. The decision of thrombolysis was indicated in urgency, and the patient benefited from thrombolysis, which proceeded without incidents; the outcome was favorable with regression of symptoms.Ischemic stroke has been widely described among the thromboembolic complications of COVID-19, but only a few papers have reported it as a primary manifestation of COVID-19. CONCLUSION: SARS-COV 2 infection can spread from the respiratory system to the central nervous system, resulting in an inflammatory response and excessive secretion of inflammatory markers, leading to ischemic stroke.

4.
Neuroepidemiology ; 56(SUPPL 1):64, 2022.
Article in English | EMBASE | ID: covidwho-1812941

ABSTRACT

Objective: The COVID-19 pandemic had impact on stroke care around the world, but middle and lowincome countries may have struggled more to cope with the spread of the virus because of its more fragile health care systems. We aimed to measure this impact on ischemic stroke acute care in the largest medical center from Latin America. Methods: We conducted an observational study from a prospective database and compared key performance indicators related to acute stroke care from ischemic stroke admissions over 1 year after the pandemic (March 16, 2020 to March 15, 2021) to 1 year before (March 16, 2019 to March 15, 2020). Results: We analyzed 1.228 ischemic stroke admissions and both groups were similar regarding to age (p = 0.4), sex (p = 0.4) and NIHSS (p = 0.1). There were 657 admissions, 139 intravenous thrombolysis (IVT) and 31 mechanical thrombectomies (MT) before the pandemic versus 571 admissions, 97 IVT and 19 MT after, representing a non-statistically significant decline from 21% to 16% of IVT (p = 0.06) and from 4% to 3% decline in MT (p = 0.2). After the pandemic, there was an increase in door-toimaging time compared to the previous year (50 x 27 minutes, p < 0.001), but there was no difference regarding to door-to-needle time for IVT (p = 0.1) or door-to-puncture for MT (p = 0.7). Conclusions: In the largest medical center from Latin America, the COVID-19 pandemic was associated with an increase in door-to-imaging time, but there was no difference regarding to IVT/MT rates or to reperfusion time indicators (door-to-needle and door-to-puncture time).

5.
Neuroepidemiology ; 56(SUPPL 1):63, 2022.
Article in English | EMBASE | ID: covidwho-1812940

ABSTRACT

Patients with severe COVID-19 may have an increased risk of venous and arterial thrombotic events, including ischemic stroke (IS). It has been hypothesized that the infection by SARS-CoV-2 alone may be a risk factor for IS, particularly in young subjects. Our objective was to compare stroke etiologies in patients with IS, with (ISCOVID+) or without (ISCOVID-) SARS-CoV-2 infection, < or 45 years. Patients ≥ 18 years with IS confirmed by computerized tomography (CT) or magnetic resonance imaging (MRI), consecutively admitted to our institution at two different periods: between April and June 2019 (ISCOVID-), and between April and August 2020 (ISCOVID+ and ISCOVID-) were included in an observational single-center cohort. Patients with molecular detection of SARS-CoV-2 before the stroke, or within 15 days after stroke or detection of serum antibodies before or within 30 days after the IS were compared with matching controls. The primary outcome was the stroke etiology according to the Causative Classification System for Ischemic Stroke (CCS) algorithm. In addition, two subgroups were determined for the category of Other uncommon Causes (OC): iatrogenic causes (OC-IC) and Other uncommon Causes excluding iatrogenic (OC-EI). A total of 212 patients were included (160 in ISCOVID+ and 42 in ISCOVID-). Cardio-aortic embolism (CE) was the most common etiology in the two groups. Two patients in the ISCOVID+ group but none in the ISCOVID-group had unexplained thrombosis of the carotid bifurcation. There were independent associations between younger age (RR 0.91, 95% CI 0.87 - 0.95) as well as COVID infection (RR 4.08;CI 95% 1.03 - 16.14) and IS due to OCEI. Classic stroke etiologies accounted for most of the cases of IS and concomitant COVID-19 infection but large-artery thrombosis was more common in infected than in non-infected patients.

6.
Neuroepidemiology ; 56(SUPPL 1):16, 2022.
Article in English | EMBASE | ID: covidwho-1812660

ABSTRACT

Background: There are no proven therapies to prevent late life cognitive impairment or slow dementia progression, although guidelines for all-cause dementia prevention align closely with those promoting cardiovascular health. Stroke and stroke risk factors increase dementia risk, with incidence of dementia almost 50 times higher in the first year after stroke compared to stroke-free individuals. Aerobic exercise reduces risk of stroke and dementia. It is included in practical risk factor modification advice, such as by the American Heart Association. Greater adherence to a healthy lifestyle, including frequent exercise, has been demonstrated to be associated with lower dementia risk. Annual incident dementia rates are 6% after stroke, similar to the annual conversion rate of mild cognitive impairment to Alzheimer's disease. Stroke patients therefore represent a high-risk group for the development of dementia, but intervention trials are few. Trial design and response to the pandemic: The Post-Ischaemic Stroke Cardiovascular Exercise Study (PISCES;ANZCTR12616000942459) is a prospectively registered, randomised, control trial examining the effects of an 8-week cardiovascular exercise intervention (active arm) delivered at 2 months after stroke compared to a stretching and balance intervention (control). Prior to the pandemic, we demonstrated good fidelity with an in-person intervention (attendance at hospital gym 3/week), but time constraints and accessibility were common barriers. The advent of COVID-19 restrictions necessitated trial restructure to allow the intervention to be delivered remotely: a Zoom-Delivered Intervention Against Cognitive decline (PISCES-ZODIAC). Discussion: Dementia trials, including those for vascular cognitive impairment trials, pose unique challenges. The long intervals required to detect meaningful cognitive decline and the intersection of co-pathologies of aging further complicates the choice of biomarkers, outcome measures and endpoints. The choice of brain volume change as a primary outcome measure and measurement of vascular cognitive impairments will be discussed, as well as the particular demands of administering an exercise intervention in stroke populations, and the utility of remote delivery for increasing access and inclusion.

7.
Science Advances ; 8(16):1-10, 2022.
Article in English | Academic Search Complete | ID: covidwho-1807300

ABSTRACT

The article presents a study which explores how portable, low-field magnetic resonance imaging (pMRI) enables highly accessible and dynamic bedside evaluation of ischemic stroke. It mentions that results validate the use of low-field pMRI to obtain clinically useful imaging of stroke, setting the stage for use in resource-limited environments.

8.
European Journal of Neurology ; 29(5):e9-e12, 2022.
Article in English | Academic Search Complete | ID: covidwho-1807076

ABSTRACT

Acute cerebral ischemia with underlying myelodysplastic syndrome mimicking vaccine-induced immune thrombotic thrombocytopenia Keywords: ischemic stroke;multilineage dysplasia;myelodysplastic syndrome;thrombosis with thrombocytopenia syndrome;vaccine-induced immune thrombotic thrombocytopenia (VITT) EN ischemic stroke multilineage dysplasia myelodysplastic syndrome thrombosis with thrombocytopenia syndrome vaccine-induced immune thrombotic thrombocytopenia (VITT) e9 e12 4 04/13/22 20220501 NES 220501 We have read with great interest the article by Krzywicka et al. describing the clinical characteristics of cerebral venous sinus thrombosis (CVST) cases following SARS-CoV-2 vaccination of which the European Medicines Agency was notified [1]. Ischemic stroke, multilineage dysplasia, myelodysplastic syndrome, vaccine-induced immune thrombotic thrombocytopenia (VITT), thrombosis with thrombocytopenia syndrome. [Extracted from the article] Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

9.
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.

10.
Journal of Stroke and Cerebrovascular Diseases ; : 106512, 2022.
Article in English | ScienceDirect | ID: covidwho-1796417

ABSTRACT

Objective The objective of this study was to evaluate how COVID-19 affects patients with acute ischemic or hemorrhagic stroke outcome. Materials and Methods This retrospective study was performed on adult patients (> 18 years old) with stroke (ischemic or hemorrhagic) who were admitted to hospital with or without COVID-19. The primary outcome was stroke-related disability, which was measured by mRS at baseline and discharge. Hospital duration, intensive care unit (ICU) admission, and mortality were considered the secondary outcomes. Results From February 2019 until August 2020, we recruited and analyzed 151 patients, 42 of whom had COVID-19 based on RT-PCR tests or lung CT scan findings. COVID-19 positive patients had higher baseline and final mRS scores than the control group (4.46± 0.67 vs 4.79± 0.61, P: 0.001, 3.83±1.22 vs 4.46± 0.67, P: 0.001). Moreover, stroke patients with COVID-19 experienced a more severe disease and required a higher rate of ICU admission (17 vs 0, P:0.001) and longer hospitalization compared to those without COVID-19 (8.50±7.86 vs 7.5±11.20, P: 0.021). Also, mortality was higher in the COVID-19 group (19 vs 13, P:0.001). There was not any significant differences between the two groups in terms of the involvement of cerebral arteries and type of stroke. Male sex, COVID-19, and ICU admission were the main independent risk factors for death. Conclusion The results of the study showed stroke patients (ischemic or hemorrhagic) with COVID-19 can have more disabilities and incur more hospital complications and mortality than non-COVID-19 patients.

11.
Neurological Care and the COVID-19 Pandemic ; : 45-55, 2021.
Article in English | Scopus | ID: covidwho-1783082

ABSTRACT

The plethora of neurological manifestations encountered in severe COVID-19 has been observed since the early days of the pandemic. The understanding that this is a novel condition, the magnitude of symptoms and signs of which is still being unraveled, cannot be overemphasized. This chapter offers a prelude to the rest of the book in which each category of neurological disorders will be discussed individually. © 2021 Elsevier Inc. All rights reserved.

12.
Neurological Care and the COVID-19 Pandemic ; : 57-72, 2021.
Article in English | Scopus | ID: covidwho-1783080

ABSTRACT

SARS-CoV-2 infects endothelial cells, induces a hypercoagulable state, and, in extreme cases, can provoke a “cytokine storm.” These etiopathological mechanisms, in addition to the hemodynamic and respiratory compromises characterizing severe COVID-19, can culminate in the emergence of various acute stroke phenotypes, such as arterial and venous thromboses, and hemorrhages. COVID-19-associated strokes have been encountered in younger patients with no cerebrovascular risk factors but the disease is also found to target older patients with comorbidities who are more likely to contract the more severe forms of the disease. Anticoagulation, antiplatelets, statins, thrombolysis and endovascular thrombectomy remain the cornerstone therapies for patients with ischemic strokes and COVID-19. An important aspect of secondary stroke prevention is blood pressure management recommendations which are currently being revisited as renin-angiotensin-aldosterone antagonists were initially thought to be detrimental to infected patients due to the interaction of the virions with ACE2 receptors. We also focus our attention on the reshaping of all aspects of stroke care during the pandemic, from the prehospital stage to telehealth. © 2021 Elsevier Inc. All rights reserved.

13.
J Clin Med ; 11(7)2022 Mar 28.
Article in English | MEDLINE | ID: covidwho-1785767

ABSTRACT

Ischemic stroke accounts for over 80% of all strokes and is one of the leading causes of mortality and permanent disability worldwide. Intravenous administration of recombinant tissue plasminogen activator (rt-PA) is an approved treatment strategy for acute ischemic stroke of large arteries within 4.5 h of onset, and mechanical thrombectomy can be used for large arteries occlusion up to 24 h after onset. Improving diagnostic work up for acute treatment, reducing onset-to-needle time and urgent radiological access angiographic CT images (angioCT) and Magnetic Resonance Imaging (MRI) are real problems for many healthcare systems, which limits the number of patients with good prognosis in real world compared to the results of randomized controlled trials. The applied endovascular procedures demonstrated high efficacy, but some cellular mechanisms, following reperfusion, are still unknown. Changes in the morphology and function of mitochondria associated with reperfusion and ischemia-reperfusion neuronal death are still understudied research fields. Moreover, future research is needed to elucidate the relationship between continuously refined imaging techniques and the variable structure or physical properties of the clot along with vascular permeability and the pleiotropism of ischemic reperfusion lesions in the penumbra, in order to define targeted preventive procedures promoting long-term health benefits.

14.
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.

15.
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.

16.
Int J Neurosci ; : 1-14, 2022 Apr 12.
Article in English | MEDLINE | ID: covidwho-1784092

ABSTRACT

Background: Coronavirus disease 2019, caused by SARS-CoV-2 (SCV-2) was stated as a pandemic on March 11 2020 by World Health Organization (WHO), and since then, it has become a major health issue worldwide. It mainly attacks the respiratory system with various accompanying complications, including cardiac injury, renal failure, encephalitis and Stroke.Materials and Methods: The current systematic review has been compiled to summarize the available literature on SCV-2 induced ischemic Stroke and its subtypes. Further, the mechanisms by which the virus crosses the blood-brain barrier (BBB) to enter the brain have also been explored. The role of CRP and D-dimer as potent prognostic markers was also explored. The literature search was carried out comprehensively on Google scholar, PubMed, SCOP US, Embase and Cochrane databases by following guidelines.Results: All the studies were reviewed thoroughly by authors and disagreements were resolved by consensus and help of the senior authors. The most common subtype of the IS was found to be large artery atherosclerosis in SCV-2 induced IS. Hypertension emerged as the most significant risk factor. The mechanism resulting in elevated levels of CRP and D-dimer have also been discussed. However, there is a scarcity of definitive evidence on how SCV-2 enters the human brain. The available literature based on various studies demonstrated that SCV-2 enters through the nasopharyngeal tract via olfactory cells to olfactory neurons, astrocytes and via choroid plexus through endothelial cells. Further, disruption of gut-brain axis has been also discussed.Conclusion: Data available in the literature is not adequate to come to a conclusion. Therefore, there is a need to carry out further studies to delineate the possible association between SCV-2 induced IS.

17.
Open Access Macedonian Journal of Medical Sciences ; 10:554-558, 2022.
Article in English | EMBASE | ID: covidwho-1780100

ABSTRACT

BACKGROUND: Since its emergence in December 2019 and declared as pandemic in March 2020, the drastic increase in cases of coronavirus disease 2019 (COVID-19) is alarming the importance of disease monitoring in order to prevent further complication, such as ischemic stroke. One of the efforts is utilizing the biomarkers. For instance, elevated homocysteine level, already known risk factor of ischemic stroke, is currently identified in COVID-19 patients. AIM: The aim of the study is to assess factors associated with homocysteine level and clinical outcomes in ischemic stroke patients with and without COVID-19. METHODS: A cross-sectional study was conducted at Dr. Zainoel Abidin Hospital di Indonesia between March and August 2021. Ischemic stroke patients who had physical and neurology examinations, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction swab, chest X-ray, electrocardiography, head computed tomography-scan and the total homocysteine level were included. To assess the factors associated with homocysteine level and the outcomes of ischemic stroke patients, the independent Student t-test or analysis of variance and Chi-squared were used, respectively. RESULTS: We included 62 ischemic stroke patients of which 32 (51.6%) were male and the age ranged between 30 and 80 years. Out of total, 60 patients (96.8%) were survived after the hospital admission. There was a significant association between gender and having COVID-19 with homocysteine level (p = 0.012 and p = 0.020, respectively). Having COVID-19 was the only variable significantly associated with the outcome of the ischemic stroke patient (p = 0.035). CONCLUSION: COVID-19 is associated with homocysteine level and the clinical outcome in ischemic stroke patients. Therefore, SARS-CoV-2 infection in ischemic stroke or vice versa needs to be monitored closely in hospital settings.

18.
Front Genet ; 13: 743905, 2022.
Article in English | MEDLINE | ID: covidwho-1775658

ABSTRACT

Aims: This study was aimed to apply a Mendelian randomization design to explore the causal association between coronavirus disease 2019 (COVID-19) and three cardio-cerebrovascular diseases, including atrial fibrillation, ischemic stroke, and coronary artery disease. Methods: Two-sample Mendelian randomization was used to determine the following: 1) the causal effect of COVID-19 on atrial fibrillation (55,114 case participants vs 482,295 control participants), coronary artery disease (34,541 case participants vs 261,984 control participants), and ischemic stroke (34,217 case participants vs 40,611 control participants), which were obtained from the European Bioinformatics Institute, and 2) the causal effect of three cardio-cerebrovascular diseases on COVID-19. The single-nucleotide polymorphisms (SNPs) of COVID-19 were selected from the summary-level genome-wide association study data of COVID-19-hg genome-wide association study (GWAS) meta-analyses (round 5) based on the COVID-19 Host Genetics Initiative for participants with European ancestry. The random-effects inverse-variance weighted method was conducted for the main analyses, with a complementary analysis of the weighted median and Mendelian randomization (MR)-Egger approaches. Results: Genetically predicted hospitalized COVID-19 was suggestively associated with ischemic stroke, with an odds ratio (OR) of 1.049 [95% confidence interval (CI) 1.003-1.098; p = 0.037] in the COVID-19 Host Genetics Initiative GWAS. When excluding the UK Biobank (UKBB) data, our analysis revealed a similar odds ratio of 1.041 (95% CI 1.001-1.082; p = 0.044). Genetically predicted coronary artery disease was associated with critical COVID-19, with an OR of 0.860 (95% CI 0.760-0.973; p = 0.017) in the GWAS meta-analysis and an OR of 0.820 (95% CI 0.722-0.931; p = 0.002) when excluding the UKBB data, separately. Limited evidence of causal associations was observed between critical or hospitalized COVID-19 and other cardio-cerebrovascular diseases included in our study. Conclusion: Our findings provide suggestive evidence about the causal association between hospitalized COVID-19 and an increased risk of ischemic stroke. Besides, other factors potentially contribute to the risk of coronary artery disease in patients with COVID-19, but not genetics.

19.
Journal of Stroke and Cerebrovascular Diseases ; : 106483, 2022.
Article in English | ScienceDirect | ID: covidwho-1773567

ABSTRACT

Objectives The aim of this study was to examine the clinical characteristics of patients with acute ischemic stroke which were previously vaccinated against Coronavirus Disease 2019 (COVID-19) and determine whether the vaccine had impact on outcome. Materials and Methods In this observational cohort study we analyzed the clinical characteristics of 58 patients with ischemic stroke, previously vaccinated against COVID-19. We analyzed demographic characteristics, risk factors, type of stroke and outcome. We also compared outcome of those patients with outcome in stroke patients hospitalized in the same period but not vaccinated, patients hospitalized during the pandemic, before vaccination began, and stroke patients hospitalized before the pandemic. Further, we compared mortality rate with mortality rate in patients who had acute ischemic stroke and COVID-19 simultaneously. Results The mean age of the patients was 71.0 years, most were male (58.6%), mostly with risk factors for stroke. In the largest number of patients, 17 (29.3%), the etiopathogenetic mechanism of stroke was atherosclerosis of the large arteries. Mortality in vaccinated patients was identical to mortality in stroke patients before pandemic, without significant difference from mortality in unvaccinated patients (13.8% versus 8.6%;p= 0.23). The mean NIHSS and mRS score at discharge for all examined groups were without significant difference. A significant difference in mortality was found between COVID-19 positive and COVID-19 negative stroke patients (37.8% versus 18.1%;p=0.001). Conclusions There are no significant differences in clinical characteristics of stroke in vaccinated compared to unvaccinated patients. We did not find a connection between vaccination and stroke.

20.
Stroke ; : 101161STROKEAHA121038250, 2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1775045

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.

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