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2.
Neurologist ; 26(6): 271-273, 2021 Nov 04.
Article in English | MEDLINE | ID: covidwho-1501227

ABSTRACT

INTRODUCTION: Wake-up strokes are challenging to manage due to unknown time of onset. Recently, the wake-up trial demonstrated that recombinant tissue plasminogen activator (rtPA) could be administered based on the magnetic resonance imaging (MRI)- diffusion weighted imaging/fluid attenuated inversion recovery mismatch. Many still doubt the safety results due to the higher rate of hemorrhagic conversion reported. Although it was statistically insignificant, the study was terminated early. Furthermore, Corona virus disease-19 is associated with coagulopathy and a higher risk of hemorrhagic conversion. CASE REPORT: A 46-year-old fully functioning male presented with a wake-up right hemiparesis, right facial droop, and expressive aphasia. His National Institute of Health Stroke Scale was 4 upon arrival. Last known well state was >4.5 hours. He tested positive for SARS-CoV-2 viral infection. He had left distal-M2 occlusion. He was deemed not a candidate for rtPA. Hyperacute-MRI protocol showed diffusion weighted imaging/fluid attenuated inversion recovery mismatch. The patient received rtPA at 6.5 hours from the last knwn well state. Follow-up MRI-susceptibility weighted imaging revealed fragmented clot. The stroke burden was less than that shown on the initial computed tomography-perfusion scans implying saved penumbra. There was no hemorrhagic conversion despite low fibrinogen levels. CONCLUSION: The hyperacute-MRI protocol for wake-up COVID-19 associated strokes might be a safe option.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Brain Ischemia/drug therapy , Diffusion Magnetic Resonance Imaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/drug therapy , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use
3.
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
4.
BMJ Case Rep ; 14(7)2021 Jul 29.
Article in English | MEDLINE | ID: covidwho-1334544

ABSTRACT

A 64-year-old female nurse was admitted to hospital following fever, cough, shortness of breath and low blood pressure. She tested positive for COVID-19 and was treated on a high-dependency unit and prescribed enoxaparin, a prophylactic anticoagulant. Eight days later, she suffered a left middle cerebral artery ischaemic stroke. Over the next 2 weeks, her condition fluctuated, eventually leading to her death. We report her case from clinical history to investigations and outcomes, and explore the potential link between coronavirus, the use of anticoagulation and ischaemic stroke.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Anticoagulants/therapeutic use , Brain Ischemia/drug therapy , Female , Humans , Middle Aged , SARS-CoV-2 , Stroke/drug therapy , Stroke/etiology
5.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(3. Vyp. 2): 60-66, 2021.
Article in Russian | MEDLINE | ID: covidwho-1206513

ABSTRACT

OBJECTIVE: To study the possibility of improving the efficacy of treatment with mexidol in COVID-19 patients with chronic cerebral ischemia (CCI). MATERIAL AND METHODS: Three hundred and four patients with CCI and COVID-19 were observed, group 1 (n=152) consisted of patients receiving basic therapy and mexidol, group 2 (n=152) received only basic therapy. Mexidol was administered intravenously for 14 days, 500 mg (10 ml) per 400 ml of saline solution, then Mexidol FORTE 250 was administered in a dose of 250 mg 3 times a day for 2 months. The state of cognitive functions (MoCA scale), sleep (Spiegel questionnaire), asthenia (MFI-20 scale), and quality of life (SIP questionnaire) were evaluated. Examinations were performed before treatment, 30 and 75 days after start of treatment. RESULTS: In group 1, there was a more complete and earlier recovery of the state of cognitive functions (an increase in indicators on the MoCA scale, p<0.01), a regression of asthenia (p<0.05), and normalization of sleep (p<0.01). By the end of the study, there were significantly more patients in group 1 with complete or significant recovery of all quality of life indicators. CONCLUSION: Long-term sequential therapy with mexidol provides a more complete recovery of impaired functions in patients with CCI and COVID-19.


Subject(s)
Brain Ischemia , COVID-19 , Asthenia , Brain Ischemia/drug therapy , Humans , Picolines/therapeutic use , Quality of Life , SARS-CoV-2
8.
Brain Behav Immun ; 91: 649-667, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064858

ABSTRACT

For the last two decades, researchers have placed hopes in a new era in which a combination of reperfusion and neuroprotection would revolutionize the treatment of stroke. Nevertheless, despite the thousands of papers available in the literature showing positive results in preclinical stroke models, randomized clinical trials have failed to show efficacy. It seems clear now that the existing data obtained in preclinical research have depicted an incomplete picture of stroke pathophysiology. In order to ameliorate bench-to-bed translation, in this review we first describe the main actors on stroke inflammatory and immune responses based on the available preclinical data, highlighting the fact that the link between leukocyte infiltration, lesion volume and neurological outcome remains unclear. We then describe what is known on neuroinflammation and immune responses in stroke patients, and summarize the results of the clinical trials on immunomodulatory drugs. In order to understand the gap between clinical trials and preclinical results on stroke, we discuss in detail the experimental results that served as the basis for the summarized clinical trials on immunomodulatory drugs, focusing on (i) experimental stroke models, (ii) the timing and selection of outcome measuring, (iii) alternative entry routes for leukocytes into the ischemic region, and (iv) factors affecting stroke outcome such as gender differences, ageing, comorbidities like hypertension and diabetes, obesity, tobacco, alcohol consumption and previous infections like Covid-19. We can do better for stroke treatment, especially when targeting inflammation following stroke. We need to re-think the design of stroke experimental setups, notably by (i) using clinically relevant models of stroke, (ii) including both radiological and neurological outcomes, (iii) performing long-term follow-up studies, (iv) conducting large-scale preclinical stroke trials, and (v) including stroke comorbidities in preclinical research.


Subject(s)
Stroke Rehabilitation/methods , Stroke/immunology , Stroke/physiopathology , Animals , Brain Ischemia/drug therapy , Comorbidity , Disease Models, Animal , Humans , Immunity/immunology , Immunity/physiology , Inflammation/immunology , Neuroprotection/immunology , Neuroprotection/physiology , Outcome Assessment, Health Care , Reperfusion/methods , Reperfusion/trends
10.
BMC Neurol ; 21(1): 4, 2021 Jan 05.
Article in English | MEDLINE | ID: covidwho-1007170

ABSTRACT

BACKGROUND: The COVID-19 pandemic, which broke out in Wuhan in 2019, has become the global health crisis of our time. Elderly patients with certain fundamental diseases are more likely to develop severe cases. The secondary lesion following viral infection have only rarely been reported. CASE PRESENTATION: We here report two cases of coronavirus-infected pneumonia with acute ischemic stroke in middle-aged patients. In both COVID-19 cases, neurological physical examinations showed normal results before infection. Lymphocytopenia, accompanied by elevated cytokines and D-dimers, were found from serum clinical laboratory examination at admission. Dysarthria and limb muscle weakness are initial manifestations, occurring one week after infect-causative pathogen, SARS-CoV-2. The head CT and head/neck arterial CTA showed small-vessel occlusion. The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke. They were treated with tirofiban and followed up with daily aspirin and atorvastatin. CONCLUSIONS: These cases suggested that secondary ischemic stroke, mainly manifested as small-vessel occlusion, should be considered for COVID-19 patients and diagnosed and treated promptly.


Subject(s)
Brain Ischemia/etiology , COVID-19/complications , Ischemic Stroke/etiology , Aspirin/therapeutic use , Atorvastatin/therapeutic use , Brain Ischemia/drug therapy , Fibrinolytic Agents/therapeutic use , Humans , Ischemic Stroke/drug therapy , Male , Middle Aged , Pandemics , SARS-CoV-2 , Tirofiban/therapeutic use
11.
Neurol Sci ; 41(9): 2325-2329, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-640307

ABSTRACT

The sudden worldwide outbreak of Coronavirus Disease 2019 (COVID-19) has certainly provided new challenges in the management of acute ischaemic stroke, and the risk-benefit ratio of intravenous thrombolysis in COVID-19 positive patients is not well known. We describe four COVID-19 patients treated with intravenous thrombolysis for acute ischaemic stroke. Although rt-PA administration is the main therapeutic strategy, our patients experienced unpredictable complications and showed atypical features: the overall mortality was very high. In conclusion, in this article, we provide information about these cases and discuss the possible explanation behind this trend.


Subject(s)
Betacoronavirus , Brain Ischemia/drug therapy , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Stroke/drug therapy , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/administration & dosage , Administration, Intravenous , Aged , Brain Ischemia/complications , Brain Ischemia/diagnostic imaging , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Recombinant Proteins/administration & dosage , SARS-CoV-2 , Stroke/complications , Stroke/diagnostic imaging
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