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1.
Stroke Vasc Neurol ; 7(2): 172-175, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1832555

ABSTRACT

BACKGROUND: Acute vestibular syndrome (AVS) features continuous dizziness and may result from a benign inner ear disorder or stroke. The head impulse-nystagmus-test of skew (HINTS) bedside assessment is more sensitive than brain MRI in identifying stroke as the cause of AVS within the first 24 hours. Clinicians' perspectives of the test in UK secondary care remains unknown. Here, we explore front-line clinicians' perspectives of use of the HINTS for the diagnosis of AVS. METHODS: Clinicians from two large UK hospitals who assess AVS patients completed a short online survey, newly designed with closed and open questions. RESULTS: Almost half of 73 total responders reported limited (n=33), or no experience (n=19), reflected in low rates of use of HINTS (n=31). While recognising the potential utility of HINTS, many reported concerns about subjectivity, need for specialist skills and poor patient compliance. No clinicians reported high levels of confidence in performing HINTS, with 98% identifying training needs. A lack of formalised training was associated with onward specialist referrals and neuroimaging (p=0.044). CONCLUSIONS: Although the low sample size in this study limits the generalisability of findings to wider sites, our preliminary data identified barriers to the application of the HINTS in AVS patients and training needs to improve rapid, cost-effective and accurate clinical diagnosis of stroke presenting with vertigo.


Subject(s)
Nystagmus, Pathologic , Stroke , Acute Disease , Head Impulse Test , Humans , Nausea , Nystagmus, Pathologic/complications , Nystagmus, Pathologic/diagnosis , Stroke/diagnosis , United Kingdom , Vertigo/diagnosis , Vertigo/etiology , Vomiting
2.
Stroke Vasc Neurol ; 7(2): 158-165, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1832554

ABSTRACT

RATIONALE: Haematoma growth is common early after intracerebral haemorrhage (ICH), and is a key determinant of outcome. Tranexamic acid, a widely available antifibrinolytic agent with an excellent safety profile, may reduce haematoma growth. METHODS AND DESIGN: Stopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units (STOP-MSU) is a phase II double-blind, randomised, placebo-controlled, multicentre, international investigator-led clinical trial, conducted within the estimand statistical framework. HYPOTHESIS: In patients with spontaneous ICH, treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with placebo. SAMPLE SIZE ESTIMATES: A sample size of 180 patients (90 in each arm) would be required to detect an absolute difference in the primary outcome of 20% (placebo 39% vs treatment 19%) under a two-tailed significance level of 0.05. An adaptive sample size re-estimation based on the outcomes of 144 patients will allow a possible increase to a prespecified maximum of 326 patients. INTERVENTION: Participants will receive 1 g intravenous tranexamic acid over 10 min, followed by 1 g intravenous tranexamic acid over 8 hours; or matching placebo. PRIMARY EFFICACY MEASURE: The primary efficacy measure is the proportion of patients with haematoma growth by 24±6 hours, defined as either ≥33% relative increase or ≥6 mL absolute increase in haematoma volume between baseline and follow-up CT scan. DISCUSSION: We describe the rationale and protocol of STOP-MSU, a phase II trial of tranexamic acid in patients with ICH within 2 hours from onset, based in participating mobile stroke units and emergency departments.


Subject(s)
Antifibrinolytic Agents , Stroke , Tranexamic Acid , Antifibrinolytic Agents/adverse effects , Cerebral Hemorrhage/chemically induced , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/drug therapy , Clinical Trials, Phase II as Topic , Hematoma/chemically induced , Hematoma/drug therapy , Humans , Multicenter Studies as Topic , Randomized Controlled Trials as Topic , Stroke/therapy , Tranexamic Acid/adverse effects
3.
Frontiers in Aging Neuroscience ; 14, 2022.
Article | ProQuest Central | ID: covidwho-1834467

ABSTRACT

Background: Handwriting is an acquired complex cognitive and motor skill resulting from the activation of a widespread brain network. Handwriting therefore may provide biologically relevant information on health status. Also, handwriting can be collected easily in an ecological scenario, through safe, cheap, and largely available tools. Hence, objective handwriting analysis through artificial intelligence would represent an innovative strategy for telemedicine purposes in healthy subjects and people affected by neurological disorders. Material and Methods: One-hundred and fifty-six healthy subjects (61 males;49.6±20.4 years) were enrolled and divided according to age into three subgroups: younger adults (YA), middle-aged adults (MA), and older adults (OA). Participants performed an ecological handwriting task that was digitalized through smartphones. Data underwent the DBNet algorithm for measuring and comparing the average stroke sizes in the three groups. A convolutional neural network (CNN) was also used to classify handwriting samples. Lastly, receiver operating characteristic (ROC) curves and sensitivity, specificity, positive, negative predictive values (PPV, NPV), accuracy and area under the curve (AUC) were calculated to report the performance of the algorithm. Results: Stroke sizes were significantly smaller in OA than in MA and YA. The CNN classifier objectively discriminated YA vs. OA (sensitivity=82%, specificity=80%, PPV=78%, NPV=79%, accuracy=77%, and AUC=0.84), MA vs. OA (sensitivity=84%, specificity=56%, PPV=78%, NPV=73%, accuracy=74%, and AUC=0.7), and YA vs. MA (sensitivity=75%, specificity=82%, PPV=79%, NPV=83%, accuracy=79%, and AUC=0.83). Discussion: Handwriting progressively declines with human ageing. The effect of physiological ageing on handwriting abilities can be detected remotely and objectively by using machine learning algorithms.

4.
Journal of Medical Internet Research ; 2022.
Article in English | ProQuest Central | ID: covidwho-1834186

ABSTRACT

Background: In 2020 and 2021, people increasingly used the internet to connect socially and professionally. However, people with an acquired brain injury (ABI) experience challenges in using social media, and rehabilitation professionals have reported feeling underprepared to support them in its use. To date, no review of social media skills training to inform ABI rehabilitation has been conducted. Objective: This scoping review aimed to examine research on interventions addressing social media skills and safety, with a focus on people living with health conditions;free web-based resources for the general public on social media skills training;and currently available online support groups for people with ABI. Methods: An integrative scoping review was conducted, with a systematic search strategy applied in March and November 2020 across OvidSP (MEDLINE, AMED, PsycINFO, and Embase), Scopus, Web of Science, CINAHL, Google Scholar, Google, and Facebook. The data collected were critically appraised and synthesized to describe the key content and features of social media training resources. Results: This review identified 47 peer-reviewed academic articles, 48 social media training websites, and 120 online support groups for people with ABI. A key recommendation was interactive training with practical components addressing cybersafety, how to use platforms, and how to connect with others. However, no social media training resources that were relevant and accessible for people with ABI were identified. Conclusions: Training resources to support people with ABI in safely using social media are limited. The key content to be addressed and the features to be incorporated into web-based social media training were determined, including the need for interactive training that is co-designed and safe and incorporates practical components that support people with ABI. These findings can be used to inform the development of web-based evidence-based support for people with ABI who may be vulnerable when participating in social media.

5.
Nursing ; 52(5):16-18, 2022.
Article in English | CINAHL | ID: covidwho-1831368

ABSTRACT

The article reports on the development by researchers of a new clinical score to stratify patients at risk for stroke when hospitalized with COVID-19, which they presented at the 2022 International Stroke Conference held in New Orleans, Louisiana in February 2022.

6.
Heart Lung Circ ; 31(2): 292-298, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1828537

ABSTRACT

BACKGROUND: Patients with Coronavirus disease 2019 (COVID-19)-related acute respiratory disease (ARDS) increasingly receive extracorporeal membrane oxygenation (ECMO) support. While ECMO has been shown to increase risk of stroke, few studies have examined this association in COVID-19 patients. OBJECTIVE: We conducted a systematic review to characterise neurological events during ECMO support in COVID-19 patients. DESIGN: Systematic review of cohort and large case series of COVID-19 patients who received ECMO support. DATA SOURCES: Studies retrieved from PubMed, EMBASE, Cochrane, Cochrane COVID-19 Study Register, Web of Science, Scopus, Clinicaltrials.gov, and medRχiv from inception to November 11, 2020. ELIGIBILITY CRITERIA: Inclusion criteria were a) Adult population (>18 year old); b) Positive PCR test for SARS-CoV-2 with active COVID-19 disease; c) ECMO therapy due to COVID-19 ARDS; and d) Neurological events and outcome described while on ECMO support. We excluded articles when no details of neurologic events were available. RESULTS: 1,322 patients from 12 case series and retrospective cohort studies were included in our study. The median age was 49.2, and 75% (n=985) of the patients were male. Diabetes mellitus and dyslipidaemia were the most common comorbidities (24% and 20%, respectively). Most (95%, n=1,241) patients were on venovenous ECMO with a median P:F ratio at the time of ECMO cannulation of 69.1. The prevalence of intracranial haemorrhage (ICH), ischaemic stroke, and hypoxic ischaemic brain injury (HIBI) was 5.9% (n=78), 1.1% (n=15), and 0.3% (n=4), respectively. The overall mortality of the 1,296 ECMO patients in the 10 studies that reported death was 36% (n=477), and the mortality of the subset of patients who had a neurological event was 92%. CONCLUSIONS: Neurological injury is a concern for COVID-19 patients who receive ECMO. Further research is required to explore how neuromonitoring protocols can inform tailored anticoagulation management and improve survival in COVID-19 patients with ECMO support.


Subject(s)
Brain Ischemia , COVID-19 , Extracorporeal Membrane Oxygenation , Stroke , Adolescent , Adult , Extracorporeal Membrane Oxygenation/adverse effects , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Stroke/epidemiology , Stroke/etiology
7.
Journal of Infection and Public Health ; 15(4):437-447, 2022.
Article in English | CAB Abstracts | ID: covidwho-1828917

ABSTRACT

Background: COVID-19 is a new coronavirus that constitutes a great challenge to human health. At this stage, there are still cases of COVID-19 infection in some countries and regions, in which ischemic stroke (IS) is a risk factor for new coronavirus pneumonia, and patients with COVID-19 infection have a dramatically elevated risk of stroke. At the same time, patients with long-term IS are vulnerable to COVID-19 infection and have more severe disease, and carotid atherosclerosis is an early lesion in IS.

8.
16th Social Simulation Conference, SSC 2021 ; : 379-391, 2022.
Article in English | Scopus | ID: covidwho-1826188

ABSTRACT

COVID-19 has caused strain on healthcare systems worldwide and concern within the population over this strain and the chances of becoming infected has reduced the likelihood of people seeking medical treatment for other health events. Stroke is a medical emergency and swift treatment can make a difference in outcomes. Understanding how concern over the COVID-19 pandemic impacts the time delay in seeking treatment after a stroke can help understand both the long-term cost implications and how to target individuals to remind them of the importance of seeking treatment. We present an agent-based model to simulate the delay in seeking treatment for stroke due to concerns over COVID-19 and show that small changes in behaviour impact the average delay in seeking treatment. We find that introducing control measures and having multiple smaller peaks of the pandemic results in less delay in seeking treatment compared to a scenario with one large peak. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

9.
Cerebrovascular Diseases. Extra ; 12(1):14-22, 2022.
Article in English | ProQuest Central | ID: covidwho-1824069

ABSTRACT

The Asia Pacific Stroke Organization is the largest international and professional stroke group in the region. It has worked consistently over the last 10 years to gain visibility and consistency across the Asia-Pacific and beyond. The 10-year journey will be reviewed in the background of many internal and external developments including changes in Asia-Pacific stroke epidemiology, stroke care systems, and stroke service developments as well as major research studies in the Asia-Pacific.

10.
The Journal of the Association of Physicians of India ; 70(4):11-12, 2022.
Article in English | Scopus | ID: covidwho-1823949

ABSTRACT

Chronic liver disease (CLD) patients develop portal hypertension which lead to complications like splenomegaly, ascites and esophageal varices. Portal hypertension is defined as hepatic venous pressure gradient more than 5mmHg, being invasive it is difficult to measure. Some studies show that increased portal vein diameter (PVD) on ultrasonography correlate with oesophageal varices and can indicate portal hypertension. Studies correlating PVD with other complications of portal hypertension like ascites and spleen size are lacking. Aim of this study was to correlate portal vein diameter with ascites, spleen size, thrombocytopenia and prognostic markers like Child-Turcotte Pugh (CTP) score and Model for End stage Liver Disease (MELD) score in Chronic liver disease patients. MATERIAL: This was a cross-sectional observational study of patients with Chronic liver disease conducted at tertiary care teaching hospital. All patient underwent clinical history, examination, blood testing and ultrasonography. Data collected was analysed by using statistical tests. OBSERVATION: Out of 97 CLD patients taken in study, the mean age of patients was 47.39 ± 12.64 year and majority were male (75.3%). Most common etiological factor was alcohol (in 53.7%). On clinical examination, 55.7% patients had pallor, 54.6% had icterus. Chest radiograph shows pleural effusion in 14.4% patients. Mean portal vein diameter was found to be 12.31 ± 2.71mm. Correlation coefficient of portal vein diameter with spleen size was 0.3 with p value of 0.004 suggesting a positive correlation. Parameters like thrombocytopenia, CTP score and MELD score correlation coefficient was -0.2(p-value: 0.066), 0.1(p value: 0.463) and 0.0(p-value: 0.725) respectively. The mean of PVD(mm) in ascites group was 12.43 and non ascites group was 11.92. Strength of association was 0.08 (Point Biserial correlation) indicating no association. CONCLUSION: Portal vein diameter had positive correlation with spleen size which is statistically significant in our study. No significant correlation was observed between PVD with ascites, thrombocytopenia, CTP score and MELD score. © Journal of the Association of Physicians of India 2011.

11.
Knowledge Management & E-Learning ; 13(4):421-437, 2021.
Article in English | ProQuest Central | ID: covidwho-1823940

ABSTRACT

The patient journey had to be modified because of the Covid-19 pandemic, causing insecurity, especially in health conditions in a time-sensitive treatment. Identifying these changes and their consequences is essential to improving the healthcare process and guaranteeing patient safety. Process mining (PM) helps evaluate the patient journey discovering care delays, bottlenecks, and non-conformities. This paper aims to apply PM to discover and analyze the patient pathway during stroke care in two different contexts, before and after the Covid-19 outbreak, and to correlate these pathways to patient outcomes. It was a retrospective cross-sectional study including 509 analyzed event logs, employing the most relevant population-based stroke registry of Latin America. Two process models were uncovered to illustrate the patient journey before and during the pandemic. The main findings were the worsening of the patient's health status at their hospital admission, the reduction of hospitalization time, the increased delay for receiving reperfusion therapies after hospital admission, and the preference for the referral hospital instead of emergency services. PM assisted in identifying time-sensitive events and allowed the improvement of patient safety. This methodology can be replicated in other healthcare studies. https//doi.org/10.34105/j.kmel.2021.13.023

12.
Case Reports in Neurology ; 14(1):208-212, 2022.
Article in English | ProQuest Central | ID: covidwho-1823790

ABSTRACT

COVID-19 has caused several neurological complications by affecting the central and peripheral nervous systems (PNS). Studies on the PNS involvement in COVID-19 are limited. These complications are likely unreported, given the difficulty of obtaining further diagnostic information, such as expert neurologist evaluation, electrodiagnostic testing, and skin biopsy. Herein, we report 2 cases of possible COVID-19-related small-fiber neuropathy (SFN). These cases are reported to increase awareness of a possible link between COVID-19 and SFN. Additional investigation, including neurology consultation, nerve conduction studies, and skin biopsy, should be considered in patients who develop paresthesia during and after COVID-19 infection. Further research is also needed to determine a possible underlying neuropathology mechanism and the role of immunomodulatory treatment, such as intravenous immunoglobulin, in COVID-19-related SFN.

13.
FASEB Journal ; 35(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1821817

ABSTRACT

Background The novel SARS-CoV-2 virus inflicts far-reaching health decrements, both directly and through secondary inflammatory stimulation. To date, there is little information regarding the effects of COVID-19 on the heart after infection, especially among young healthy adults. Purpose We sought to determine whether contracting SARS-CoV-2 affects cardiac function in young, otherwise healthy adults and whether these alterations recede after testing positive for SARS-CoV-2. Methods Transthoracic echocardiography was performed on 7 subjects with SARS-CoV-2 (3F/4M, 21±1y, 24±2 kg m ) who tested positive 3-4 weeks prior to baseline testing followed by 1- month and 2-month follow-up testing. A parasternal long-axis view was utilized to measure septal and left ventricular posterior wall thickness, left ventricular volume, and left ventricular outflow tract dimensions. A four-chamber view was utilized to measure mitral and tricuspid valve, left ventricular, and pulmonary vein function. Data are mean±SD. Results Stroke volume (Baseline: 44±11ml, 1-month: 42±13ml, 2-month: 54±12ml) and stroke index (Baseline: 24±6ml/m

14.
Archives of Physical Medicine and Rehabilitation ; 2022.
Article in English | ScienceDirect | ID: covidwho-1821132

ABSTRACT

Healthcare delivery shifted and adapted with the coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome (SARS) coronavirus 2 (CoV-2). Stroke care was negatively impacted across the care continuum and may lead to poor community living outcomes in those who survived a stroke during the ongoing pandemic. For instance, delays in seeking care, changes in length of stays, and shifts in discharge patterns were observed during the pandemic. Those seeking care were younger and had more severe neurological effects from stroke. Increased strain was placed on caregivers and public health efforts and community-wide lockdowns, albeit necessary to reduce the spread of COVID-19, had detrimental effects on treatment and recommendations to support community living outcomes. The American Congress of Rehabilitation Medicine (ACRM) Stroke Interdisciplinary Special Interest Group (Stroke ISIG) Health and Wellness Task Force convened to (1) discuss international experiences in stroke care and rehabilitation and (2) review recently published literature on stroke care and outcomes during the pandemic. Based on the findings in the literature, the task force proposes recommendations and interdisciplinary approaches at the (1) institutional and societal level, (2) healthcare delivery level, and (3) individual/interpersonal level spanning across the care continuum and into the community.

15.
Telemedicine and E-Health ; : 22, 2022.
Article in English | Web of Science | ID: covidwho-1819772

ABSTRACT

Introduction: The COVID-19 pandemic ushered in a rapid, transformative adoption of telemedicine to maintain patient access to care. As clinicians made the shift from in-person to virtual practice, they faced a paucity of established and reliable clinical examination standards for virtual care settings. In this systematic review, we summarize the accuracy and reliability of virtual assessments compared with traditional in-person examination tools.Methods: We searched PubMed, Embase, Web of Science, and CINAHL from inception through September 2019 and included additional studies from handsearching of reference lists. We included studies that compared synchronous video (except allowing for audio-only modality for cardiopulmonary exams) with in-person clinical assessments of patients in various settings. We excluded behavioral health and dermatological assessments. Two investigators ed data using a predefined protocol.Results: A total of 64 studies were included and categorized into 5 clinical domains: neurological (N = 41), HEENT (head, eyes, ears, nose, and throat;N = 5), cardiopulmonary (N = 5), musculoskeletal (N = 8), and assessment of critically ill patients (N = 5). The cognitive assessment within the neurological exam was by far the most studied (N = 19) with the Mini-Mental Status Exam found to be highly reliable in multiple settings. Most studies showed relatively good reliability of the virtual assessment, although sample sizes were often small (<50 participants).Conclusions: Overall, virtual assessments performed similarly to in-person exam components for diagnostic accuracy but had a wide range of interrater reliability. The high heterogeneity in population, setting, and outcomes reported across studies render it difficult to draw broad conclusions on the most effective exam components to adopt into clinical practice. Further work is needed to identify virtual exam components that improve diagnostic accuracy.

16.
Neuroimmunology Reports ; : 100100, 2022.
Article in English | ScienceDirect | ID: covidwho-1819577

ABSTRACT

Indroduction Thrombotic complications leading to cerebrovascular events occuring in conjunction with Covid-19 vaccination though rare, is well-documented. Moyamoya Angiopathy is a progressive intracranial vasculopathy leading to recurrent strokes. Case presentation We present two index cases of young patient presenting with stroke and TIA following Covid-19 vaccination (COVISHIELD) leading to unmasking of Moyamoya Angiopathy. Conclusion Arterial stroke following Covid-19 vaccination is documented, but uncommon. However, in the background of a vasculopathy, it may not be so rare. Moyamoya Angiopathy has been closely studied in the model of inflammatory pathophysiology in genetically predisposed patients leading to progressive vaso-occlusive disease. Few reports of Covid-19 infection potentiating Moyamoya Angiopathy symptoms are also documented. Thus, as an extrapolation of the inflammatory etiopathogenesis of Moyamoya Angiopathy, Covid-19 vaccination can similarly affect the Moyamoya symptomatology. These two index cases open new lines of enquiry regarding the interplay of Covid-19 vaccination and neurological destabilization in patients with underlying vasculopathy of inflammatory pathophysiology.

17.
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.

18.
Clinical Neurosurgery ; 67(SUPPL 1):131, 2020.
Article in English | EMBASE | ID: covidwho-1816190

ABSTRACT

INTRODUCTION: Covid 19 infections has been shown to be associated with a range of thromboembolic disease that has implications for the neuro-endovascular management of large vessel occlusions. METHODS: Five consecutive Covid-19 positive patients presented with large vessel occlusions to our institution. Covid-19 testing was performed using nasal swab. All thrombectomy cases was performed under general endotracheal anesthesia using a stent-aspiration combination as primary thrombectomy technique. The technical details of each case and the angiographic outcome are described. Routine labs including D-dimer, platelet count, coagulation panel (aPTT, INR), Interleukin 6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were evaluated in all patients. Rotational thrombelastography (ROTEM) was performed on the patients' blood samples to assess real-time clot formation/dissolution properties. RESULTS: Four patients had anterior circulation large vessel occlusions and one patient had both anterior and posterior circulation occlusions. Mean age was 52.8 years and 80% were males. TICI 3 revascularization was achieved in one patient, TICI 2B achieved in two patients and TICI 2A in two patients. In our cohort, patients were on average 52.8 years old and presented with a median NIHSS of 27. All our patients had very proximal occlusions. Three patients presented with intra-cranial ICA occlusions. Two patients presented with a tandem carotid bulb thrombus in conjunction with an intracranial vessel occlusion. One patient had an ICA terminus occlusion with a concomitant basilar occlusion. Second, the intravascular clots in all our patients were prone to fragment and migrate into both new vascular territories and into distal downstream vasculature. Distal emboli into a different territory (anterior cerebral artery occlusion) was seen in two two of our five patients (40%) and distal emboli into a downstream territory was seen in all five patients (100%). An average of 2.7 pstent-retriever passes was needed to achieve a final TICI revascularization of IIb or better. CONCLUSION: Covid-19 patients are predisposed to a hypercoagulable state. When presenting with large vessel occlusions, these patients present unique challenges that make successful revascularization difficult.

19.
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.

20.
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.

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