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1.
J Stroke Cerebrovasc Dis ; 30(8): 105919, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1253283

ABSTRACT

BACKGROUND: The characteristics and pathophysiological mechanisms involved in acute ischemic stroke in patients with COVID-19 infection have not been fully clarified. We prospectively studied the phenotypic and etiological features of acute stroke occurring in COVID-19 infection. PATIENTS & METHODS: Within nine months starting from April-2020, the presence of COVID-19 infection was determined by thoracic CT and SARS-CoV-2 PCR in all acute stroke cases managed in a single tertiary center. Consecutive and prospective data on vascular risk factors/comorbidities, in-hospital quality metrics, discharge outcomes, etiological subclassification and blood markers of thrombosis / inflammation were compared in 44 COVID-19 positive cases (37 acute ischemic stroke, 5 TIA, 2 intracerebral hematoma) and 509 COVID-19 negative patients (355 ischemic, 105 TIA, 44 hematoma and 5 stroke mimic). RESULTS: COVID-19 positive patients had more severe strokes, delayed hospital admission, longer hospital stay, higher mortality rates, but had similar vascular risk factors/comorbidities frequency, thrombolysis/thrombectomy utilization rates, metrics, and stroke etiological subtype. They had significantly higher CRP, fibrinogen, ferritin, leukocyte count and lower lymphocyte count. No difference was detected in aPTT, INR, D-dimer, platelet, hemoglobin, homocysteine levels and ANA, anti-dsDNA antibody and ENA panel positivity rates. Anti-phospholipid antibodies have been studied in 70% of COVID-19 positive and all cryptogenic patients, but were never found positive. Tests for coagulation factor levels and hereditary thrombophilia did not show major thrombophilia in any of the stroke patients with COVID-19. CONCLUSION: We documented that there is no significant difference in etiological spectrum in acute stroke patients with COVID-19 infection. In addition, cryptogenic stroke and antiphospholipid antibody positivity rates did not increase.


Subject(s)
COVID-19/complications , Hemorrhagic Stroke/etiology , Ischemic Attack, Transient/etiology , Ischemic Stroke/etiology , Aged , Aged, 80 and over , Biomarkers/blood , Blood Coagulation , COVID-19/diagnosis , COVID-19/therapy , COVID-19/virology , Case-Control Studies , Female , Hemorrhagic Stroke/diagnosis , Hemorrhagic Stroke/therapy , Humans , Inflammation Mediators/blood , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/therapy , Ischemic Stroke/diagnosis , Ischemic Stroke/therapy , Male , Middle Aged , Prognosis , Prospective Studies , Risk Assessment , Risk Factors
2.
Neurol Sci ; 42(2): 445-453, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1006439

ABSTRACT

BACKGROUND: Some previous reports have shown a reduced number of admission in stroke cases during the coronavirus disease 2019 (COVID-19) pandemic period. The present study aimed to investigate this changing pattern and the potential causes behind it at an academic neurology and neurosurgery center in Iran. METHODS: Patients admitted to our center with the diagnosis of ischemic and hemorrhagic stroke, between March 1, 2019, Jun 1, 2019, and the similar 3-month period in 2020 (COVID-19 pandemic period), were compared in terms of clinical characteristics and outcome. Poisson regression was also conducted to assess the correlation between daily admissions and the COVID-19 pandemic period. RESULTS: A total of 210 patients with stroke (ischemic and hemorrhagic) in 2019 were compared with 106 patients in 2020. COVID-19 pandemic period was significantly associated with the decline in the number of daily admissions in ischemic stroke (IRR, 0.51 [95% CI, 0.4-0.64]). A significant reduction (P = 0.003) in time from onset to arrival at hospital from median 12 h [IQR, 5-32] in 2019 to median 6 h [IQR, 4-16] in 2020 was found in ischemic stroke cases. National Institute of Health Stroke Scale (NIHSS) was significantly increased (P < 0.001) from median 4 [IQR, 2-7] in 2019 to median 9 [IQR, 4-14] in 2020. Glasgow coma scale (GCS) was significantly decreased from 13.9 (SD, 2) in 2019 to 12.8 (SD, 2.9) in 2020 (P < 0.001). CONCLUSIONS: The present study provided new pieces of evidence regarding the changed pattern of hospital admission in stroke especially the possible reasons for its decline.


Subject(s)
Academic Medical Centers/statistics & numerical data , COVID-19 , Hemorrhagic Stroke/therapy , Ischemic Stroke/therapy , Patient Admission/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Adult , Aged , Aged, 80 and over , Female , Glasgow Coma Scale , Hemorrhagic Stroke/epidemiology , Humans , Iran/epidemiology , Ischemic Stroke/epidemiology , Male , Middle Aged , Retrospective Studies , Severity of Illness Index
3.
Eur Neurol ; 83(6): 630-635, 2020.
Article in English | MEDLINE | ID: covidwho-992126

ABSTRACT

Coronavirus disease-2019 (COVID-19) has become a pandemic disease globally. The First Affiliated Hospital of Chengdu Medical College has adopted telestroke to make stroke care accessible in remote areas. During the period January 2020 to March 2020, there was no COVID-19 case reported in our stroke center. A significant reduction of stroke admission was observed between the ischemic stroke group (235 vs. 588 cases) and the intracerebral hemorrhage group (136 vs. 150 cases) when compared with the same period last year (p < 0.001). The mean door-to-needle time (DNT) and door-to-puncture time (DPT) was 62 and 124 min, respectively. Compared to the same period last year, a significant change was observed in DNT (62 ± 12 vs. 47 ± 8 min, p = 0.019) but not in DPT (124 ± 58 vs. 135 ± 23 min, p = 0.682). A total of 46 telestroke consultations were received from network hospitals. Telestroke management in the central hospital was performed on 17 patients. Of them, 3 (17.6%) patients had brain hernia and died in hospital and 8 (47.1%) patients were able to ambulation at discharge and had a modified Rankin Scale of 0-2 at 3 months. The COVID-19 pandemic impacted stroke care significantly in our hospital, including prehospital and in-hospital settings, resulting in a significant drop in acute ischemic stroke admissions and a delay in DNT. The construction of a telestroke network enabled us to extend health-care resources and make stroke care accessible in remote areas. Stroke education and public awareness should be reinforced during the COVID-19 pandemic.


Subject(s)
COVID-19 , Hemorrhagic Stroke/therapy , Ischemic Stroke/therapy , Telemedicine/methods , Thrombectomy/statistics & numerical data , Thrombolytic Therapy/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Aged , Aged, 80 and over , Female , Functional Status , Hospitalization , Hospitals , Humans , Male , Middle Aged , Multi-Institutional Systems/organization & administration , Pandemics , SARS-CoV-2 , Stroke/epidemiology , Telemedicine/organization & administration , Treatment Outcome
4.
J Stroke Cerebrovasc Dis ; 30(2): 105429, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-899244

ABSTRACT

The current Coronavirus pandemic due to the novel SARS-Cov-2 virus has proven to have systemic and multi-organ involvement with high acuity neurological conditions including acute ischemic strokes. We present a case series of consecutive COVID-19 patients with cerebrovascular disease treated at our institution including 3 cases of cerebral artery dissection including subarachnoid hemorrhage. Knowledge of the varied presentations including dissections will help treating clinicians at the bedside monitor and manage these complications preemptively.


Subject(s)
Aneurysm, Dissecting/mortality , COVID-19/mortality , Hemorrhagic Stroke/mortality , Hospital Mortality , Intensive Care Units , Intracranial Aneurysm/mortality , Ischemic Stroke/mortality , Patient Admission , Adult , Aged , Aged, 80 and over , Aneurysm, Dissecting/diagnosis , Aneurysm, Dissecting/therapy , COVID-19/diagnosis , COVID-19/therapy , Female , Hemorrhagic Stroke/diagnosis , Hemorrhagic Stroke/therapy , Humans , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/therapy , Ischemic Stroke/diagnosis , Ischemic Stroke/therapy , Male , Middle Aged , New York City/epidemiology , Prospective Studies , Risk Assessment , Risk Factors
5.
Can J Neurol Sci ; 48(1): 122-126, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-662470

ABSTRACT

This is an observational cohort study comparing 156 patients evaluated for acute stroke between March 30 and May 31, 2020 at a comprehensive stroke center with 138 patients evaluated during the corresponding time period in 2019. During the pandemic, the proportion of COVID-19 positive patients was low (3%), the time from symptom onset to hospital presentation was significantly longer, and a smaller proportion of patients underwent reperfusion therapy. Among patients directly evaluated at our institution, door-to-needle and door-to-recanalization metrics were significantly longer. Our findings support concerns that the current pandemic may have a negative impact on the management of acute stroke.


Subject(s)
COVID-19 , Hemorrhagic Stroke/therapy , Ischemic Stroke/therapy , Thrombectomy/trends , Thrombolytic Therapy/trends , Time-to-Treatment/trends , Aged , Aged, 80 and over , Endovascular Procedures/trends , Female , Humans , Male , Middle Aged , Quebec , SARS-CoV-2
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