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2.
Neurologist ; 26(6): 261-267, 2021 Nov 04.
Article in English | MEDLINE | ID: covidwho-1501229

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been shown to associate with increased risk of thromboembolic events. Mechanical thrombectomy (MT) has long been used to effectively manage those with large-vessel occlusive (LVO) stroke and has similarly been implemented in the management of stroke in COVID-19 patients. REVIEW SUMMARY: The COVID-19 pandemic took the health care sector by a storm. Thus, less is known about MT outcomes in this population and evidence suggesting poor outcomes postthrombectomy for COVID-19 patients is accumulating. We provide a narrative on some of the published studies on the outcomes of MT in COVID-19 patients with LVO between March 2020 and February 2021. A description of patient characteristics, risk factors, COVID-19 infection severity, stroke features and thrombectomy success in this population is also presented as data from several studies show that LVO in COVID-19 patients may have some distinguishing characteristics that make management more challenging. CONCLUSIONS: The effect of COVID-19 on the long-term prognosis of stroke patients after thrombectomy is yet to be determined. The accumulating evidence from current studies indicates a negative impact of COVID-19 on outcomes in acute ischemic stroke patients who receive MT, irrespective of timely, successful angiographic recanalization. This review may help alert clinicians of some of the COVID-19-specific postthrombectomy challenges.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Brain Ischemia/complications , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/surgery , Thrombectomy , Treatment Outcome
3.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(8. Vyp. 2): 5-10, 2021.
Article in Russian | MEDLINE | ID: covidwho-1436429

ABSTRACT

Neurological complications of COVID-19 occur in almost a third of patients. According to various studies, the frequency of cerebrovascular manifestations in patients with a positive test result for SARS-CoV-2 ranges from 1% to 3%. The most common manifestation was acute ischemic stroke. Cerebrovascular complications in COVID-19 patients are likely multifactorial. They can be associated with coagulopathy, systemic inflammatory response, endothelial dysfunction and microthrombosis, as well as organ failure, impaired cardiac functions. The peculiarities of stroke in patients with COVID-19 include occlusion of large vessels, involvement of several vascular pools, a high incidence of damage to the vertebrobasilar system, a cryptogenic nature and a high severity of the course with high mortality and disability. Particular attention should be paid to impaired cognitive functions as a clinical manifestation of the consequences of stroke associated with a new coronavirus infection.


Subject(s)
Brain Ischemia , COVID-19 , Nervous System Diseases , Stroke , Brain Ischemia/complications , Humans , SARS-CoV-2
4.
Acta Neurol Scand ; 145(1): 47-52, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1367290

ABSTRACT

OBJECTIVE: Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the core medical therapy of acute ischaemic stroke (AIS). COVID-19 infection negatively modifies acute stroke procedures and, due to its pro-coagulative effect, may potentially impact on IVT outcome. Thus, short-term efficacy and safety of IVT were compared in patients with and without evidence of SARS-CoV-2. METHODS: An observational, retrospective study included 70 patients with AIS, including 22 subjects (31%) with evidence of acute COVID-19 infection, consecutively treated with IVT in 4 stroke centres between 15 September and 30 November 2020. RESULTS: Patients infected with COVID-19 were characterized by higher median of National Institute of Health Stroke Scale (NIHSS) score (11.0 vs. 6.5; p < .01) and D-dimers (870 vs. 570; p = .03) on admission, higher presence of pneumonia (47.8% vs. 12%; p < .01) and lower percentage of 'minor stroke symptoms' (NIHSS 1-5 pts.) (2% vs., 18%; p < .01). Hospitalizations were longer in patients with COVID-19 than in those without it (17 vs. 9 days, p < .01), but impact of COVID-19 infection on patients' in-hospital mortality or functional status on dismission has been confirmed neither in uni- or multivariate analysis. CONCLUSION: SARS-CoV-2 infection prolongs length of stay in hospital after IVT, but does not influence in-hospital outcome.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Brain Ischemia/complications , Brain Ischemia/drug therapy , Fibrinolytic Agents/therapeutic use , Humans , Retrospective Studies , SARS-CoV-2 , Stroke/complications , Stroke/drug therapy , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Treatment Outcome
5.
J Headache Pain ; 22(1): 93, 2021 Aug 12.
Article in English | MEDLINE | ID: covidwho-1357018

ABSTRACT

BACKGROUND: We report the first case of a patient who suffered transient focal neurological deficit mimicking stroke following CoronaVac vaccination. However, instead of an ischemic stroke, motor aura was suspected. CASE PRESENTATIONS: A 24 year-old Thai female presented with left hemiparesis fifteen minutes after receiving CoronaVac. She also had numbness of her left arm and legs, flashing lights, and headaches. On physical examination, her BMI was 32.8. Her vital signs were normal. She had moderate left hemiparesis (MRC grade III), numbness on her left face, arms, and legs. Her weakness continued for 5 days. A brain CT scan was done showing no evidence of acute infarction. Acute treatment with aspirin was given. MRI in conjunction with MRA was performed in which no restricted diffusion was seen. A SPECT was performed to evaluate the function of the brain showing significant hypoperfusion of the right hemisphere. The patient gradually improved and was discharged. DISCUSSIONS: In this study, we present the first case of stroke mimic after CoronaVac vaccination. After negative imaging studies had been performed repeatedly, we reach a conclusion that stroke is unlikely to be the cause. Presumably, this phenomenon could possibly have abnormal functional imaging study. Therefore, we believed that it might be due to cortical spreading depression, like migraine aura, which we had conducted a literature review.


Subject(s)
Brain Ischemia , COVID-19 , Epilepsy , Ischemic Stroke , Migraine with Aura , Stroke , Adult , Brain Ischemia/complications , Brain Ischemia/diagnostic imaging , Female , Humans , SARS-CoV-2 , Stroke/complications , Stroke/diagnostic imaging , Vaccination , Young Adult
6.
Eur J Neurol ; 29(1): 105-113, 2022 01.
Article in English | MEDLINE | ID: covidwho-1348130

ABSTRACT

BACKGROUND AND PURPOSE: Many countries worldwide, including Germany, reported that the first wave of the coronavirus disease 2019 (COVID-19) pandemic in early 2020 influenced the care of acute ischemic stroke (AIS) patients, but data are lacking for further pandemic wave periods. METHODS: We conducted a nationwide, retrospective, cross-sectional study of all hospitalized patients with the main diagnosis of AIS in 2019 and 2020. Primary outcomes were the number of hospitalizations for AIS, the application of stroke unit care, intravenous thrombolysis (IVT), and mechanical thrombectomy (MT), as well as the in-hospital mortality during the different pandemic periods in 2020 compared to the corresponding periods in 2019. Secondarily, we analyzed differences in outcomes between patients with and without concurrent COVID-19. RESULTS: We included 429,841 cases with AIS, of which 1268 had concurrent COVID-19. Hospitalizations for AIS declined during both pandemic wave periods in 2020 (first wave: -10.9%, second wave: -4.6%). MT rates were consistently higher throughout 2020 compared to 2019, whereas the IVT rate dropped during the second wave period (16.0% vs. 17.0%, p < 0.001). AIS patients with concurrent COVID-19 frequently received recanalization treatments, with an overall MT rate of 8.4% and IVT rate of 15.9%. The in-hospital mortality was high (22.8% vs. 7.5% in noninfected AIS patients, p < 0.001). CONCLUSIONS: These findings demonstrate a smaller decline in hospitalizations for AIS in the more severe second wave of the COVID-19 pandemic. AIS patients with and without concurrent COVID-19 who did seek acute care continued to receive recanalization treatments in Germany.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Brain Ischemia/complications , Brain Ischemia/epidemiology , Brain Ischemia/therapy , Cross-Sectional Studies , Germany/epidemiology , Humans , Pandemics , Patient Care , Retrospective Studies , SARS-CoV-2 , Stroke/drug therapy , Stroke/therapy , Thrombectomy , Thrombolytic Therapy , Treatment Outcome
7.
Eur J Neurol ; 28(11): 3826-3836, 2021 11.
Article in English | MEDLINE | ID: covidwho-1316884

ABSTRACT

Since the onset of the COVID-19 pandemic, a substantial proportion of COVID-19 patients had documented thrombotic complications and ischemic stroke. Several mechanisms related to immune-mediated thrombosis, the renin angiotensin system and the effect of SARS-CoV-2 in cardiac and brain tissue may contribute to the pathogenesis of ischemic stroke in patients with COVID-19. Simultaneously, significant strains on global healthcare delivery, including ischemic stroke management, have made treatment of stroke in the setting of COVID-19 particularly challenging. In this review, we summarize the current knowledge on epidemiology, clinical manifestation, and pathophysiology of ischemic stroke in patients with COVID-19 to bridge the gap from bench to bedside and clinical practice during the most challenging global health crisis of the last decades.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Brain Ischemia/complications , Brain Ischemia/epidemiology , Humans , Pandemics , SARS-CoV-2 , Stroke/epidemiology , Stroke/therapy
10.
Neurol Sci ; 42(7): 2645-2651, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1217442

ABSTRACT

OBJECTIVE: We aim to determine the risk of acute ischemic stroke in patients with severe and non-severe coronavirus disease 2019 (COVID-19). METHODS: A literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases until October 28, 2020. Studies covering COVID-19's severity classification data and COVID-19 patients with acute ischemic stroke were included. Two independent evaluators extracted data, and the random effects model was used to calculate the risk ratios (RR) and 95% confidence interval (95% CI) of acute ischemic stroke associated with COVID-19's severity. RESULTS: A total of 8 studies were included, involving 5266 patients. Among all COVID-19 patients, the total incidence of ischemic stroke was 1.76% (95% CI: 0.82-3.01). Severe patients have an increased risk of acute ischemic stroke compared with non-severe patients (RR = 3.53, 95% CI: 2.06-6.07, P < 0.0001; I2 = 12%). This association was also observed when COVID-19's severity was defined by clinical parameters (RR 2.91, 95% CI: 1.17-7.26, P = 0.02; I2 = 29%) and the need for intensive care (RR 4.47, 95% CI: 2.40-8.31, P < 0.0001; I2 = 0%). CONCLUSIONS: This meta-analysis shows that the severe course of COVID-19 is associated with an increased risk of acute ischemic stroke.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Brain Ischemia/complications , Brain Ischemia/epidemiology , Humans , SARS-CoV-2 , Stroke/epidemiology
11.
J Neurol ; 268(12): 4443-4447, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1206873

ABSTRACT

COVID-19 (Coronavirus disease 2019) caused by SARS-CoV-2 has a diverse constellation of neurological manifestations that include encephalopathy, stroke, Guillain-Barré syndrome, myelitis, and encephalitis. Intraluminal carotid thrombi (ILT) are infrequent lesions seen in only 1.6% of patients with acute ischemic stroke. Underlying atherosclerosis is the most common lesion associated with ILT formation. However, with COVID-19, we have encountered ILT in patients without significant atherosclerotic disease. The endothelial inflammation and hypercoagulable state associated with COVID-19 pose a risk of arterial and venous thromboembolism and could have contributed to this presentation although the exact pathophysiology and optimal treatment of ILT in COVID-19 remain elusive. Herein, we present a series of ischemic stroke patients with carotid ILT in the setting of a recent SARS-CoV-2 infection.


Subject(s)
Brain Ischemia , COVID-19 , Carotid Artery Thrombosis , Ischemic Stroke , Stroke , Brain Ischemia/complications , Carotid Artery Thrombosis/complications , Carotid Artery Thrombosis/diagnostic imaging , Humans , SARS-CoV-2 , Stroke/complications
12.
Stroke ; 52(5): 1895-1904, 2021 05.
Article in English | MEDLINE | ID: covidwho-1166638

ABSTRACT

The Coronavirus disease 2019 (COVID)-19 pandemic has already affected millions worldwide, with a current mortality rate of 2.2%. While it is well-established that severe acute respiratory syndrome-coronavirus-2 causes upper and lower respiratory tract infections, a number of neurological sequelae have now been reported in a large proportion of cases. Additionally, the disease causes arterial and venous thromboses including pulmonary embolism, myocardial infarction, and a significant number of cerebrovascular complications. The increasing incidence of large vessel ischemic strokes as well as intracranial hemorrhages, frequently in younger individuals, and associated with increased morbidity and mortality, has raised questions as to why the brain is a major target of the disease. COVID-19 is characterized by hypercoagulability with alterations in hemostatic markers including high D-dimer levels, which are a prognosticator of poor outcome. Together with findings of fibrin-rich microthrombi, widespread extracellular fibrin deposition in affected various organs and hypercytokinemia, this suggests that COVID-19 is more than a pulmonary viral infection. Evidently, COVID-19 is a thrombo-inflammatory disease. Endothelial cells that constitute the lining of blood vessels are the primary targets of a thrombo-inflammatory response, and severe acute respiratory syndrome coronavirus 2 also directly infects endothelial cells through the ACE2 (angiotensin-converting enzyme 2) receptor. Being highly heterogeneous in their structure and function, differences in the endothelial cells may govern the susceptibility of organs to COVID-19. Here, we have explored how the unique characteristics of the cerebral endothelium may be the underlying reason for the increased rates of cerebrovascular pathology associated with COVID-19.


Subject(s)
Brain Ischemia/complications , Brain/physiopathology , COVID-19/complications , Endothelial Cells/cytology , Ischemic Stroke/complications , Angiotensin-Converting Enzyme 2/metabolism , Blood Coagulation , Brain Ischemia/physiopathology , COVID-19/physiopathology , Cytokines/metabolism , Fibrin/chemistry , Fibrin Fibrinogen Degradation Products/chemistry , Hemostasis , Humans , Hypoxia , Incidence , Inflammation , Ischemic Stroke/physiopathology , Myocardial Infarction/physiopathology , Pandemics , Prognosis
13.
Stroke ; 52(5): 1885-1894, 2021 05.
Article in English | MEDLINE | ID: covidwho-1166635

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 or coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the correlation with this viral illness and increased risk of stroke. Although it is too early in the pandemic to know the strength of the association between COVID-19 and stroke, it is an opportune time to review the relationship between acute viral illnesses and stroke. Here, we summarize pathophysiological principles and available literature to guide understanding of how viruses may contribute to ischemic stroke. After a review of inflammatory mechanisms, we summarize relevant pathophysiological principles of vasculopathy, hypercoagulability, and hemodynamic instability. We will end by discussing mechanisms by which several well-known viruses may cause stroke in an effort to inform our understanding of the relationship between COVID-19 and stroke.


Subject(s)
Brain Ischemia/complications , Brain Ischemia/physiopathology , COVID-19/complications , COVID-19/epidemiology , Ischemic Stroke/complications , Ischemic Stroke/physiopathology , Acute Disease , Blood Coagulation , Brain Ischemia/virology , Hemodynamics , Herpesvirus 3, Human , Humans , Inflammation/physiopathology , Ischemic Stroke/virology , Pandemics , Plaque, Atherosclerotic/physiopathology , Risk , Thrombophilia/physiopathology , Thrombosis/physiopathology , Vascular Diseases/physiopathology , Virus Diseases/physiopathology
16.
J Neurol ; 268(10): 3561-3568, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1121219

ABSTRACT

Whether and how SARS-CoV-2 outbreak affected in-hospital acute stroke care system is still matter of debate. In the setting of the STROKOVID network, a collaborative project between the ten centers designed as hubs for the treatment of acute stroke during SARS-CoV-2 outbreak in Lombardy, Italy, we retrospectively compared clinical features and process measures of patients with confirmed infection (COVID-19) and non-infected patients (non-COVID-19) who underwent reperfusion therapies for acute ischemic stroke. Between March 8 and April 30, 2020, 296 consecutive patients [median age, 74 years (interquartile range (IQR), 62-80.75); males, 154 (52.0%); 34 (11.5%) COVID-19] qualified for the analysis. Time from symptoms onset to treatment was longer in the COVID-19 group [230 (IQR 200.5-270) minutes vs. 190 (IQR 150-245) minutes; p = 0.007], especially in the first half of the study period. Patients with COVID-19 who underwent endovascular thrombectomy had more frequently absent collaterals or collaterals filling ≤ 50% of the occluded territory (50.0% vs. 16.6%; OR 5.05; 95% CI 1.82-13.80) and a lower rate of good/complete recanalization of the primary arterial occlusive lesion (55.6% vs. 81.0%; OR 0.29; 95% CI 0.10-0.80). Post-procedural intracranial hemorrhages were more frequent (35.3% vs. 19.5%; OR 2.24; 95% CI 1.04-4.83) and outcome was worse among COVID-19 patients (in-hospital death, 38.2% vs. 8.8%; OR 6.43; 95% CI 2.85-14.50). Our findings showed longer delays in the intra-hospital management of acute ischemic stroke in COVID-19 patients, especially in the early phase of the outbreak, that likely impacted patients outcome and should be the target of future interventions.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Aged , Brain Ischemia/complications , Brain Ischemia/epidemiology , Brain Ischemia/therapy , Hospital Mortality , Humans , Italy/epidemiology , Male , Reperfusion , Retrospective Studies , SARS-CoV-2 , Stroke/epidemiology , Stroke/therapy , Thrombectomy
18.
Clin Neurol Neurosurg ; 199: 106227, 2020 12.
Article in English | MEDLINE | ID: covidwho-1023513

ABSTRACT

OBJECTIVE: To compare ischemic and hemorrhagic stroke patients with COVID-19 to non-COVID-19 controls, and to describe changes in stroke admission patterns during the pandemic. METHODS: This is a single center, retrospective, observational study. All consecutive patients admitted with primary diagnosis of ischemic/ hemorrhagic stroke between March1st -May10th 2020 were included and compared with the same time period in 2019. RESULTS: There was a 41.9% increase in stroke admissions in 2020 (148 vs 210,P = .001). When comparing all ischemic strokes, higher rate of large vessel occlusion (LVO) (18.3% vs 33.8%,P = .008) and significant delay in initiation of mechanical thrombectomy after hospital arrival (67.75 vs 104.30 minutes,P = .001) was observed in 2020. When comparing all hemorrhagic strokes, there were no differences between the two years. Among 591 COVID-19 admissions, 31 (5.24%) patients with stroke including 19 with ischemic (3.21%) and 12 with hemorrhagic stroke (2.03%) were identified. Patients with COVID-19 and ischemic stroke were significantly younger (58.74 vs 48.11 years,P = .002), predominantly male (68.18% vs 94.74%,P = .016), had lesser vascular risk factors, had more severe clinical presentation (NIHSS 7.01 vs 17.05,P < .001), and higher rate of LVO (23.6% vs. 63.1%,P = .006). There was no difference in the rate of endovascular thrombectomy, but time to groin puncture was significantly longer in COVID-19 patients (83.41 vs 129.50 minutes,P = .003). For hemorrhagic stroke, COVID-19 patients did not differ from non-COVID-19 patients. CONCLUSIONS: Stroke continues to occur during this pandemic and stroke pathways have been affected by the pandemic. Stroke occurs in approximately 5% of patients with COVID-19. COVID-19 associated ischemic stroke occurs in predominantly male patients who are younger, with fewer vascular risk factors, can be more severe, and have higher rates of LVO. Despite an increase in LVO during the pandemic, treatment with mechanical thrombectomy has not increased. COVID-19 associated hemorrhagic stroke does not differ from non-COVID-19 hemorrhagic stroke patients.


Subject(s)
COVID-19/complications , Hospitalization , SARS-CoV-2 , Stroke/epidemiology , Stroke/therapy , Adult , Aged , Brain Ischemia/complications , Brain Ischemia/diagnosis , Brain Ischemia/therapy , COVID-19/mortality , COVID-19/therapy , Endovascular Procedures , Female , Humans , Intracranial Hemorrhages/complications , Intracranial Hemorrhages/diagnosis , Intracranial Hemorrhages/therapy , Male , Middle Aged , Retrospective Studies , Risk Factors , Stroke/mortality , Survival Rate , Thrombectomy , United Arab Emirates
20.
Stroke ; 51(9): e254-e258, 2020 09.
Article in English | MEDLINE | ID: covidwho-992145

ABSTRACT

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4-18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4-18] versus 6 [IQR, 3-14]), P=0.03; (odds ratio, 1.69 [95% CI, 1.08-2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2-6] versus 2 [IQR, 1-4], P<0.001) and death (odds ratio, 4.3 [95% CI, 2.22-8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.


Subject(s)
Brain Ischemia/complications , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/complications , Aged , Aged, 80 and over , Brain Ischemia/diagnostic imaging , Brain Ischemia/therapy , COVID-19 , Cohort Studies , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/therapy , Disability Evaluation , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/therapy , Propensity Score , Recovery of Function , Registries , Stroke/diagnostic imaging , Stroke/therapy , Survival Analysis , Time-to-Treatment , Tomography, X-Ray Computed , Treatment Outcome
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