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1.
Curr Neurol Neurosci Rep ; 23(6): 301-325, 2023 Jun.
Article in English | MEDLINE | ID: covidwho-20240872

ABSTRACT

PURPOSE OF REVIEW: Uncommon causes of stroke merit specific attention; when clinicians have less common etiologies of stoke in mind, the diagnosis may come more easily. This is key, as optimal management will in many cases differs significantly from "standard" care. RECENT FINDINGS: Randomized controlled trials (RCT) on the best medical therapy in the treatment of cervical artery dissection (CeAD) have demonstrated low rates of ischemia with both antiplatelet and vitamin K antagonism. RCT evidence supports the use of anticoagulation with vitamin K antagonism in "high-risk" patients with antiphospholipid antibody syndrome (APLAS), and there is new evidence supporting the utilization of direct oral anticoagulation in malignancy-associated thrombosis. Migraine with aura has been more conclusively linked not only with increased risk of ischemic and hemorrhagic stroke, but also with cardiovascular mortality. Recent literature has surprisingly not provided support the utilization of L-arginine in the treatment of patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS); however, there is evidence at this time that support use of enzyme replacement in patients with Fabry disease. Additional triggers for reversible cerebral vasoconstriction syndrome (RCVS) have been identified, such as capsaicin. Imaging of cerebral blood vessel walls utilizing contrast-enhanced MRA is an emerging modality that may ultimately prove to be very useful in the evaluation of patients with uncommon causes of stroke. A plethora of associations between cerebrovascular disease and COVID-19 have been described. Where pertinent, authors provide additional tips and guidance. Less commonly encountered conditions with updates in diagnosis, and management along with clinical tips are reviewed.


Subject(s)
COVID-19 , Migraine Disorders , Stroke , Humans , COVID-19/complications , Stroke/therapy , Stroke/complications , Migraine Disorders/complications , Anticoagulants/therapeutic use , Fibrinolytic Agents , Vitamin K
2.
BMC Neurol ; 23(1): 161, 2023 Apr 22.
Article in English | MEDLINE | ID: covidwho-2322628

ABSTRACT

INTRODUCTION: Digital twins, a form of artificial intelligence, are virtual representations of the physical world. In the past 20 years, digital twins have been utilized to track wind turbines' operations, monitor spacecraft's status, and even create a model of the Earth for climate research. While digital twins hold much promise for the neurocritical care unit, the question remains on how to best establish the rules that govern these models. This model will expand on our group's existing digital twin model for the treatment of sepsis. METHODS: The authors of this project collaborated to create a Direct Acyclic Graph (DAG) and an initial series of 20 DELPHI statements, each with six accompanying sub-statements that captured the pathophysiology surrounding the management of acute ischemic strokes in the practice of Neurocritical Care (NCC). Agreement from a panel of 18 experts in the field of NCC was collected through a 7-point Likert scale with consensus defined a-priori by ≥ 80% selection of a 6 ("agree") or 7 ("strongly agree"). The endpoint of the study was defined as the completion of three separate rounds of DELPHI consensus. DELPHI statements that had met consensus would not be included in subsequent rounds of DELPHI consensus. The authors refined DELPHI statements that did not reach consensus with the guidance of de-identified expert comments for subsequent rounds of DELPHI. All DELPHI statements that reached consensus by the end of three rounds of DELPHI consensus would go on to be used to inform the construction of the digital twin model. RESULTS: After the completion of three rounds of DELPHI, 93 (77.5%) statements reached consensus, 11 (9.2%) statements were excluded, and 16 (13.3%) statements did not reach a consensus of the original 120 DELPHI statements. CONCLUSION: This descriptive study demonstrates the use of the DELPHI process to generate consensus among experts and establish a set of rules for the development of a digital twin model for use in the neurologic ICU. Compared to associative models of AI, which develop rules based on finding associations in datasets, digital twin AI created by the DELPHI process are easily interpretable models based on a current understanding of underlying physiology.


Subject(s)
Artificial Intelligence , Stroke , Humans , Consensus , Delphi Technique , Intensive Care Units , Critical Care , Stroke/therapy
3.
Trials ; 23(1): 518, 2022 Jun 20.
Article in English | MEDLINE | ID: covidwho-2317491

ABSTRACT

BACKGROUND: There is a pressing need for scalable healthcare solutions and a shift in the rehabilitation paradigm from hospitals to homes to tackle the increase in stroke incidence while reducing the practical and economic burden for patients, hospitals, and society. Digital health technologies can contribute to addressing this challenge; however, little is known about their effectiveness in at-home settings. In response, we have designed the RGS@home study to investigate the effectiveness, acceptance, and cost of a deep tech solution called the Rehabilitation Gaming System (RGS). RGS is a cloud-based system for delivering AI-enhanced rehabilitation using virtual reality, motion capture, and wearables that can be used in the hospital and at home. The core principles of the brain theory-based RGS intervention are to deliver rehabilitation exercises in the form of embodied, goal-oriented, and task-specific action. METHODS: The RGS@home study is a randomized longitudinal clinical trial designed to assess whether the combination of the RGS intervention with standard care is superior to standard care alone for the functional recovery of stroke patients at the hospital and at home. The study is conducted in collaboration with hospitals in Spain, Sweden, and France and includes inpatients and outpatients at subacute and chronic stages post-stroke. The intervention duration is 3 months with assessment at baseline and after 3, 6, and 12 months. The impact of RGS is evaluated in terms of quality of life measurements, usability, and acceptance using standardized clinical scales, together with health economic analysis. So far, one-third of the patients expected to participate in the study have been recruited (N = 90, mean age 60, days after stroke ≥ 30 days). The trial will end in July 2023. DISCUSSION: We predict an improvement in the patients' recovery, high acceptance, and reduced costs due to a soft landing from the clinic to home rehabilitation. In addition, the data provided will allow us to assess whether the prescription of therapy at home can counteract deterioration and improve quality of life while also identifying new standards for online and remote assessment, diagnostics, and intervention across European hospitals. TRIAL REGISTRATION: C linicalTrials.gov NCT04620707. Registered on November 3, 2020.


Subject(s)
Stroke Rehabilitation , Stroke , Telemedicine , Humans , Middle Aged , Quality of Life , Randomized Controlled Trials as Topic , Recovery of Function , Stroke/diagnosis , Stroke/therapy , Stroke Rehabilitation/methods
4.
BMJ Open ; 13(5): e072493, 2023 05 10.
Article in English | MEDLINE | ID: covidwho-2313206

ABSTRACT

INTRODUCTION: Comprehensive studies mapping domain-specific trajectories of recovery after stroke and biomarkers reflecting these processes are scarce. We, therefore, initiated an exploratory prospective observational study of stroke cases with repeated evaluation, the FIND Stroke Recovery Study. We aim to capture trajectories of recovery from different impairments, including cognition, in combination with broad profiling of blood and imaging biomarkers of the recovery. METHODS AND ANALYSIS: We recruit individuals with first-ever stroke at the stroke unit at the Sahlgrenska University Hospital, Sweden, to FIND. The inclusion started early 2018 and we aim to enrol minimum 500 patients. Neurological and cognitive impairments across multiple domains are assessed using validated clinical assessment methods, advanced neuroimaging is performed and blood samples for biomarker measuring (protein, RNA and DNA) at inclusion and follow-up visits at 3 months, 6 months, 1 year, 2 years and 5 years poststroke. At baseline and at each follow-up visit, we also register clinical variables known to influence outcomes such as prestroke functioning, stroke severity, acute interventions, rehabilitation, other treatments, socioeconomic status, infections (including COVID-19) and other comorbidities. Recurrent stroke and other major vascular events are identified continuously in national registers. ETHICS AND DISSEMINATION: FIND composes a unique stroke cohort with detailed phenotyping, repetitive assessments of outcomes across multiple neurological and cognitive domains and patient-reported outcomes as well as blood and imaging biomarker profiling. Ethical approval for the FIND study has been obtained from the Regional Ethics Review Board in Gothenburg and the Swedish Ethics Review Board. The results of this exploratory study will provide novel data on the time course of recovery and biomarkers after stroke. The description of this protocol will inform the stroke research community of our ongoing study and facilitate comparisons with other data sets. TRIAL REGISTRATION NUMBER: The protocol is registered at http://www. CLINICALTRIALS: gov, Study ID: NCT05708807.


Subject(s)
COVID-19 , Stroke , Humans , Biomarkers , Cohort Studies , Longitudinal Studies , Observational Studies as Topic , Stroke/therapy
6.
J Stroke Cerebrovasc Dis ; 32(6): 107138, 2023 Jun.
Article in English | MEDLINE | ID: covidwho-2302577

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate the impact of COVID-19 pandemic public health restrictions on our drip and ship mechanical thrombectomy program in Santiago Chile. MATERIALS AND METHODS: This was a retrospective analysis of a prospectively collected database comparing two cohorts, one during a two-year period before COVID-19 and the second during the two years of the pandemic at our metropolitan stroke program. RESULTS: A total of 100 patients were included in the pre COVID-19 cohort (cohort 1) and 121 in the COVID-19 cohort (cohort 2). There was a significant difference between cohorts, with older patients, different occlusion sites and higher door to arterial puncture time during the COVID-19 period. A non-significant trend for worse 90-day outcomes and higher mortality was present in cohort 2. There were no statistical differences in safety treatment parameters. CONCLUSIONS: COVID-19 pandemic has had a measurable impact on our mechanical thrombectomy program. Results showed similarities to other reported Latin American series, where less robust health systems could adapt less efficiently compared to developed countries. After two years of public health restrictions, there were changes in the treatment population characteristics, delay in some internal management metrics and a non-significant trend to worse 90-day outcomes and higher mortality.


Subject(s)
Brain Ischemia , COVID-19 , Stroke , Humans , Post-Acute COVID-19 Syndrome , Brain Ischemia/therapy , Thrombectomy/adverse effects , Thrombectomy/methods , Retrospective Studies , COVID-19/epidemiology , Pandemics , Public Health , Treatment Outcome , Stroke/diagnosis , Stroke/therapy , Stroke/epidemiology
7.
J Stroke Cerebrovasc Dis ; 32(6): 107140, 2023 Jun.
Article in English | MEDLINE | ID: covidwho-2291491

ABSTRACT

OBJECTIVE: To study factors associated with systolic blood pressure(SBP) control for patients post-discharge from an ischemic stroke or transient ischemic attack(TIA) during the early months of the COVID-19 pandemic compared to pre-pandemic periods within the Veterans Health Administration(VHA). MATERIALS AND METHODS: We analyzed retrospective data from patients discharged from Emergency Departments or inpatient admissions after an ischemic stroke or TIA. Cohorts consisted of 2,816 patients during March-September 2020 and 11,900 during the same months in 2017-2019. Outcomes included primary care or neurology clinic visits, recorded blood pressure readings and average blood pressure control in the 90-days post-discharge. Random effect logit models were used to compare clinical characteristics of the cohorts and relationships between patient characteristics and outcomes. RESULTS: The majority (73%) of patients with recorded readings during the COVID-19 period had a mean post-discharge SBP within goal (<140 mmHg); this was slightly lower than the pre-COVID-19 period (78%; p=0.001). Only 38% of the COVID-19 cohort had a recorded SBP in the 90-days post-discharge compared with 83% of patients during the pre-pandemic period (p=0.001). During the pandemic period, 29% did not have follow-up primary care or neurologist visits, and 33% had a phone or video visit without a recorded SBP reading. CONCLUSIONS: Patients with an acute cerebrovascular event during the initial COVID-19 period were less likely to have outpatient visits or blood pressure measurements than during the pre-pandemic period; patients with uncontrolled SBP should be targeted for follow-up hypertension management.


Subject(s)
COVID-19 , Ischemic Attack, Transient , Ischemic Stroke , Stroke , Humans , Blood Pressure/physiology , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/therapy , Pandemics , Retrospective Studies , Aftercare , Patient Discharge , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapy , Ischemic Stroke/diagnosis , Ischemic Stroke/epidemiology , Ischemic Stroke/therapy
8.
Can J Neurol Sci ; 48(1): 9-24, 2021 01.
Article in English | MEDLINE | ID: covidwho-2278901

ABSTRACT

BACKGROUND: Albeit primarily a disease of respiratory tract, the 2019 coronavirus infectious disease (COVID-19) has been found to have causal association with a plethora of neurological, neuropsychiatric and psychological effects. This review aims to analyze them with a discussion of evolving therapeutic recommendations. METHODS: PubMed and Google Scholar were searched from 1 January 2020 to 30 May 2020 with the following key terms: "COVID-19", "SARS-CoV-2", "pandemic", "neuro-COVID", "stroke-COVID", "epilepsy-COVID", "COVID-encephalopathy", "SARS-CoV-2-encephalitis", "SARS-CoV-2-rhabdomyolysis", "COVID-demyelinating disease", "neurological manifestations", "psychosocial manifestations", "treatment recommendations", "COVID-19 and therapeutic changes", "psychiatry", "marginalised", "telemedicine", "mental health", "quarantine", "infodemic" and "social media". A few newspaper reports related to COVID-19 and psychosocial impacts have also been added as per context. RESULTS: Neurological and neuropsychiatric manifestations of COVID-19 are abundant. Clinical features of both central and peripheral nervous system involvement are evident. These have been categorically analyzed briefly with literature support. Most of the psychological effects are secondary to pandemic-associated regulatory, socioeconomic and psychosocial changes. CONCLUSION: Neurological and neuropsychiatric manifestations of this disease are only beginning to unravel. This demands a wide index of suspicion for prompt diagnosis of SARS-CoV-2 to prevent further complications and mortality.


Les impacts neurologiques et neuropsychiatriques d'une infection à la COVID-19. CONTEXTE: Bien qu'il s'agisse principalement d'une maladie des voies respiratoires, la maladie infectieuse à coronavirus apparue en 2019 (COVID-19) s'est avérée avoir un lien de causalité avec une pléthore d'impacts d'ordre neurologique, neuropsychiatrique et psychologique. Cette étude entend donc analyser ces impacts tout en discutant l'évolution des recommandations thérapeutiques se rapportant à cette maladie. MÉTHODES: Les bases de données PubMed et Google Scholar ont été interrogées entre les 1er janvier et 30 mai 2020. Les termes clés suivants ont été utilisés : « COVID-19 ¼, « SRAS ­ CoV-2 ¼, « Pandémie ¼, « Neuro ­ COVID ¼, « AVC ­ COVID ¼, « Épilepsie ­ COVID ¼, « COVID ­ encéphalopathie ¼, « SRAS ­ CoV-2 ­ encéphalite ¼, « SRAS ­ CoV-2 ­ rhabdomyolyse ¼, « COVID ­ maladie démyélinisante ¼, « Manifestations neurologiques ¼, « Manifestations psychosociales ¼, « Recommandations thérapeutiques ¼, « COVID-19 et changement thérapeutiques ¼, « Psychiatrie ¼, « Marginalisés ¼, « Télémédecine ¼, « Santé mentale ¼, « Quarantaine ¼, « Infodémique ¼ et « Médias sociaux ¼. De plus, quelques articles de journaux relatifs à la pandémie de COVID-19 et à ses impacts psychosociaux ont également été ajoutés en fonction du contexte. RÉSULTATS: Il appert que les manifestations neurologiques et neuropsychiatriques des infections à la COVID-19 sont nombreuses. Les caractéristiques cliniques d'une implication des systèmes nerveux central et périphérique sautent désormais aux yeux. Ces caractéristiques ont fait l'objet d'une brève analyse systématique à l'aide de publications scientifiques. En outre, la plupart des impacts d'ordre psychologique de cette pandémie se sont révélés moins apparents que les changements réglementaires, socioéconomiques et psychosociaux. CONCLUSION: Les manifestations neurologiques et neuropsychiatriques de cette maladie ne font que commencer à être élucidées. Cela exige donc une capacité accrue de vigilance en vue d'un diagnostic rapide, et ce, afin de prévenir des complications additionnelles et une mortalité accrue.


Subject(s)
COVID-19/physiopathology , Nervous System Diseases/physiopathology , Ageusia/etiology , Ageusia/physiopathology , Alzheimer Disease/therapy , Angiotensin-Converting Enzyme 2 , Anosmia/etiology , Anosmia/physiopathology , Brain Diseases , COVID-19/complications , COVID-19/epidemiology , COVID-19/psychology , Cerebellar Ataxia/etiology , Cerebellar Ataxia/physiopathology , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/physiopathology , Comorbidity , Delivery of Health Care , Demyelinating Diseases/therapy , Disease Management , Dizziness/etiology , Dizziness/physiopathology , Epilepsy/therapy , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Headache/etiology , Headache/physiopathology , Humans , Hypoxia, Brain/physiopathology , Inflammation/physiopathology , Meningoencephalitis/etiology , Meningoencephalitis/physiopathology , Muscular Diseases/etiology , Muscular Diseases/physiopathology , Myelitis, Transverse/etiology , Myelitis, Transverse/physiopathology , Myoclonus/etiology , Myoclonus/physiopathology , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Parkinson Disease/therapy , Polyneuropathies/etiology , Polyneuropathies/physiopathology , SARS-CoV-2 , Seizures/etiology , Seizures/physiopathology , Stroke/therapy , Viral Tropism
9.
Can J Neurol Sci ; 48(1): 87-93, 2021 01.
Article in English | MEDLINE | ID: covidwho-2254254

ABSTRACT

OBJECTIVE: The study sought to explore the experiences of participants affected by stroke with home video visit (HVV) for follow-up visits in order to understand the determinants, barriers, and benefits associated with HVVs. METHODS: Semi-structured interviews were conducted with (n = 23) participants to gather insight and descriptive information about patients' experiences with HVV. Specifically, we sought to collect descriptions about the (1) costs and time associated with in-person visits, (2) facilitators and barriers to in-person and virtual visits, and (3) their values attached to traditional and virtual forms of patient care. RESULTS: HVVs were perceived to be a mode of healthcare that is time-saving and convenient for both participants and physicians. However, our study also found some participants felt uncomfortable using technology to conduct medical visits while others still supported a positive view of traditional forms of in-person visits because they valued the in-person interactions and safe environment of the hospital. CONCLUSION: While HVVs were considered to be useful in addressing geographical barriers to health care, technological and digital health literacy may serve to impede seniors from using the service, with some of them opting to go to the hospital despite geographical barriers. Resultantly, HVVs may serve both to alleviate and exacerbate certain determinants to health care.


Subject(s)
Stroke , Telemedicine , Costs and Cost Analysis , Delivery of Health Care , Humans , Stroke/therapy
11.
Semin Pediatr Neurol ; 44: 100997, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2283454

ABSTRACT

Global awareness of stroke as a significant cause of neurologic sequelae and death in children has increased over the years as more data in this field becomes available. However, most published literature on pediatric stroke have limited geographic representation. Data on childhood stroke from developing countries remains limited. Thus, this paper reviewed geographic/ethnic differences in pediatric stroke risk factors highlighting those reported in low- and middle-income countries, and proposes a childhood arterial ischemic stroke diagnostic algorithm for resource limited settings. Stroke risk factors include cardiac disorders, infectious diseases, cerebral arteriopathies, hematologic disorders, inflammatory diseases, thrombophilia and genetic conditions. Infection of the central nervous system particularly tuberculous meningitis, is a leading cause of pediatric arterial ischemic stroke in developing countries. Stroke should be considered in children with acute focal neurologic deficit especially in the presence of aforementioned risk factors. Cranial magnetic resonance imaging with angiography is the neuroimaging modality of choice but if unavailable, cranial computed tomography with angiography may be performed as an alternative. If both are not available, transcranial doppler together with neurologic exam may be used to screen children for arterial ischemic stroke. Etiological diagnosis follows with the aid of appropriate laboratory tests that are available in each level of care. International collaborative research on stroke risk factors that are prevalent in low and middle income countries will provide information for drafting of stroke care guidelines that are universal yet inclusive taking into consideration regional differences in available resources with the goal of reducing global stroke burden.


Subject(s)
Ischemic Stroke , Stroke , Child , Humans , Stroke/diagnosis , Stroke/therapy , Ultrasonography, Doppler, Transcranial , Neurologic Examination , Central Nervous System
12.
J Stroke Cerebrovasc Dis ; 32(4): 107036, 2023 Apr.
Article in English | MEDLINE | ID: covidwho-2273586

ABSTRACT

OBJECTIVES: Early in the pandemic, there was a substantial increase in telestroke uptake among hospitals. The motivations for using telestroke during the pandemic might have been different than for hospitals that adopted telestroke previously. We compared stroke care at hospitals that adopted telestroke prior to the pandemic to care at hospitals that adopted telestroke during the pandemic. MATERIALS AND METHODS: Stroke episodes and telestroke use were identified in Medicare Fee-for-Service Data. Hospital and episode characteristics were compared between pre-pandemic (Jan. 2019-Mar. 2020) and pandemic (Apr. 2020-Dec. 2020) adopters. RESULTS: Hospital bed counts, critical access statuses, stroke volumes, clinical operating margins, shares of stroke care via telestroke, and vascular neurology consult rates did not differ significantly between pre-pandemic and pandemic-adopting hospitals. Hospitals that never adopted telestroke during the study period were more likely to be small critical access hospitals with low clinical operating margins. CONCLUSIONS: Compared to hospitals that adopted telestroke before the pandemic, hospitals that adopted telestroke during the pandemic were similar in characteristics and how they used telestroke.


Subject(s)
COVID-19 , Stroke , Telemedicine , Aged , Humans , United States/epidemiology , Pandemics , Medicare , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapy , Thrombolytic Therapy
13.
J Stroke Cerebrovasc Dis ; 32(5): 107082, 2023 May.
Article in English | MEDLINE | ID: covidwho-2271864

ABSTRACT

PURPOSE: To compare quality of life (QOL) of individuals with stroke three months after hospital discharge, using generic and specific QOL measures, before and during the COVID-19 pandemic. METHODS: Individuals, who were admitted to a public hospital, were recruited and evaluated before (G1) and during (G2) the COVID-19 pandemic. The groups were matched for age, sex, socio-economic status, and levels of stroke severity (National Institutes of Health Stroke Scale) and functional dependence (Modified Barthel Index). After three months of hospital discharge, they were evaluated and compared using generic (Short-form Health Survey 36: SF-36) and specific (Stroke Specific Quality of Life: SSQOL) QOL measures. RESULTS: Seventy individuals were included (35 in each group). Statistically significant between-group differences were found for both total SF-36 (p=0.008) and SSQOL (p=0.001) scores, indicating that individuals reported worse QOL during the COVID-19 pandemic. Furthermore, G2 also reported worse generic QOL related to the SF-36 domains of physical functioning, bodily pain, general health perception, and emotional role limitations (p < 0.01) and worse specific QOL related to following SSQOL domains: Family roles, mobility, mood, personality, and social roles (p < 0.05). Finally, G2 reported better QOL related to energy and thinking (p < 0.05) SSQOL domains. CONCLUSION: In general, individuals with stroke, who were evaluated during the COVID-19 pandemic three months after hospital discharge, reported worse perceptions of QOL in several domains of both generic and specific QOL measures.


Subject(s)
COVID-19 , Stroke , Humans , Quality of Life/psychology , Patient Discharge , Pandemics , Stroke/diagnosis , Stroke/therapy , Hospitals
14.
Curr Opin Neurol ; 36(2): 155-164, 2023 04 01.
Article in English | MEDLINE | ID: covidwho-2271393

ABSTRACT

PURPOSE OF REVIEW: COVID-19 is an ongoing global pandemic since it was first discovered in 2020. Cerebral vascular disease and stroke are among the most common and devastating neurological manifestations of COVID-19. This review offers an up-to-date information on the possible underlying mechanism of COVID-19-related stroke, its diagnosis, and management. RECENT FINDINGS: The thromboembolism associated with COVID-19 infection is likely related to the cytokine storm with innate immune activation, pulmonary disease leading to hypoxia-induced ischemia, thrombotic microangiopathy, endothelial damage and multifactorial activation of the coagulation cascade. Currently, there is no clear guidelines on the use of antithrombotics for the prevention and treatment of this phenomenon. SUMMARY: COVID-19 infection can directly cause a stroke or facilitate the formation of thromboembolism in the presence of other medical conditions. Physicians treating patients with COVID-19 should stay vigilant about the signs and symptoms of stroke, detect and treat early.


Subject(s)
COVID-19 , Cerebrovascular Disorders , Stroke , Thromboembolism , Humans , COVID-19/complications , Cerebrovascular Disorders/therapy , Stroke/etiology , Stroke/therapy , Pandemics
16.
PLoS One ; 18(2): e0282325, 2023.
Article in English | MEDLINE | ID: covidwho-2279290

ABSTRACT

OBJECTIVE: To explore experiences, needs and rehabilitation priorities of patients who had their stroke and the experiences of therapists managing stroke patients during the COVID-19 pandemic. DESIGN: Exploratory qualitative study. SETTING: Acute, sub-acute and community stroke facilities. SUBJECTS: Twenty-two participants. Twelve therapists (all female, mean age 38.5 years) and ten patients (9 female, mean age 51.1 years) who were involved in stroke rehabilitation during the pandemic were interviewed. METHODS: Individual semi-structured interviews were conducted. Interviews were recorded and transcribed before being analysed using a reflexive thematic analysis approach. RESULTS: Four main themes demonstrate the modifications in the care system as a result of COVID-19, impact on the stroke patients at different stage, needs and priorities of stroke rehabilitation, and management strategies that have been used in stroke rehabilitation. Remote rehabilitation and self-management strategies were recommended to deliver care for stroke patients. However, therapists seemed unsatisfied with the quality of care delivered and patients suggested face to face delivery of care with proper personal protection equipment to better address their physical and mental health needs. CONCLUSION: The findings of this study explored the impact of the pandemic on stroke care from the perspective of the patients and therapists and provides suggestions for improved delivery of care in similar situations. Future research is warranted to examine the long-term effects on people who had inadequate post-stroke rehabilitation during covid pandemic and urgent measures taken to reduce the impact the pandemic has had on the physical and mental issues for these patients.


Subject(s)
COVID-19 , Stroke Rehabilitation , Stroke , Humans , Female , Adult , Middle Aged , COVID-19/epidemiology , Pandemics , Stroke/epidemiology , Stroke/therapy , Allied Health Personnel
17.
Brain Behav ; 13(5): e2977, 2023 05.
Article in English | MEDLINE | ID: covidwho-2277216

ABSTRACT

BACKGROUND: Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time-dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect. METHODS: One hospital-based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset-to-door time (ODT) in the first 50%, while the door-to-needle time (DNT) was in the last quartile. DNT (in-hospital delay) was further subdivided into several time intervals [door-to-examination time (DET), door-to-imaging time (DIT), door-to-laboratory time (DLT), and decision-making time (DMT) of the patients or their proxies. RESULTS: A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female. Baseline characteristics were similar between the two groups (all p > .05). For the comparisons of the time intervals, DIT (26 versus 15 min, p = .001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p > .05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036-1.118; p < .001], and history of coronary heart disease (OR, 3.898; 95%CI, 1.415-10.735; p = .008) were independently associated with deadline effect in the binary logistic regression model, while admitted in the working day (OR, 0.674; 95%CI, 0.096-0.907; p = .033), and having medical insurance (OR, 0.350; 95% CI, 0.132-0.931; p = .035) were negatively associated with the deadline effect. CONCLUSIONS: A speed-safety tradeoff phenomenon from the deadline effect was observed in 17.2% of IVT cases during the COVID-19 pandemic, where longer DIT contributed a lot to this time delay. Patients without medical insurance, or admitted in official holidays were more likely to experience a delay of the deadline effect.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Thrombosis , Humans , Female , Aged , Male , Stroke/therapy , Ischemic Stroke/drug therapy , Thrombolytic Therapy/methods , Pandemics , Fibrinolytic Agents/therapeutic use , Brain Ischemia/drug therapy , Treatment Outcome
18.
Eur J Neurol ; 30(4): 943-950, 2023 04.
Article in English | MEDLINE | ID: covidwho-2280371

ABSTRACT

BACKGROUND AND PURPOSE: During the coronavirus disease 2019 (COVID-19) pandemic many countries reported a decline in stroke volumes. The aim of this study was to analyze if the decline was related to the intensity of the COVID-19 pandemic. METHODS: The first pandemic year (1 March 2020 to 28 February 2021) overall and during the three COVID-19 waves were compared with the preceding year. Volumes of acute ischaemic stroke (AIS), subarachnoid hemorrhage, intracerebral hemorrhage and recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) were obtained from the National Register of Reimbursed Health Services. Door-to-needle time, onset-to-door time and National Institutes of Health Stroke Scale at admission were obtained from the Registry of Stroke Care Quality. RESULTS: During the pandemic year compared to the preceding year there were 26,453 versus 28,771 stroke admissions, representing an 8.8% decline (p < 0.001). The declines (-10%, -11%, -19%) appeared in COVID-19 waves (spring 2020, autumn 2020, winter 2021) except for an increase (2%) during summer 2020. Admissions for AIS declined by 10.2% (p < 0.001), whilst hemorrhagic stroke volumes were minimally decreased. The absolute volumes of IVT and MT decreased by 9.4% (p < 0.001) and 5.7% (p = 0.16), respectively. However, the proportions of ischaemic stroke patients receiving IVT (18% vs. 18%; p = 0.72) and MT (6% vs. 6%; p = 0.28) remained unchanged. CONCLUSIONS: There was a decline in stroke admissions, but such decline was not related to COVID-19 incidence. The frequency of use of recanalization procedures (IVT, MT) and times (onset-to-door time, door-to-needle time) in AIS were preserved in the Czech Republic during the first year of the pandemic.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Humans , Stroke/therapy , Brain Ischemia/therapy , Thrombolytic Therapy/methods , Thrombectomy/methods , Pandemics , Treatment Outcome , Hospitalization
19.
CNS Neurosci Ther ; 29(3): 757-759, 2023 03.
Article in English | MEDLINE | ID: covidwho-2288763
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