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1.
Stroke ; 52(5): e117-e130, 2021 05.
Article in English | MEDLINE | ID: covidwho-1195876
2.
J Clin Neurol ; 17(2): 155-163, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1175631

ABSTRACT

Coronavirus disease 2019 (COVID-19) can reportedly manifest as an acute stroke, with most cases presenting as large vessel ischemic stroke in patients with or without comorbidities. The exact pathomechanism of stroke in COVID-19 remains ambiguous. The findings of previous studies indicate that the most likely underlying mechanisms are cerebrovascular pathological conditions following viral infection, inflammation-induced endothelial dysfunction, and hypercoagulability. Acute endothelial damage due to inflammation triggers a coagulation cascade, thrombosis propagation, and destabilization of atherosclerosis plaques, leading to large-vessel occlusion and plaque ulceration with concomitant thromboemboli, and manifests as ischemic stroke. Another possible mechanism is the downregulation of angiotensin-converting enzyme 2 as the target action of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Acute stroke management protocols need to be modified during the COVID-19 pandemic in order to adequately manage stroke patients with COVID-19.

3.
J Prev Interv Community ; 49(2): 127-135, 2021.
Article in English | MEDLINE | ID: covidwho-1172608

ABSTRACT

Patients with COVID-19 may present with neurological manifestations, lack of oxygenation, or clotting disorders such as ischemic or hemorrhagic strokes. This has been observed in even young patients with mild symptoms. The aim of this study was to explore current online news coverage of acute stroke associated with COVID-19 in the four-month period from April 2020 to July 2020, a time during which the US found itself in the center of the pandemic. The relevant Google News stories were reviewed for content. The analysis indicated that 118 online news reports covered the topic to varying degrees, including data from reputable sources, references to the neurological symptoms, and to the incidence of stroke in young patients. It is important that health professionals be aware of this risk and convey to the public the possibility of stroke due to COVID-19 so as to increase the probability of early diagnosis and optimal outcomes.


Subject(s)
COVID-19 , Internet , Mass Media , Stroke/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Information Storage and Retrieval , Male , Middle Aged , SARS-CoV-2 , Stroke/mortality , United States/epidemiology , Young Adult
4.
Front Neurol ; 11: 604907, 2020.
Article in English | MEDLINE | ID: covidwho-983703

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) has a long incubation period and a high degree of infectivity. Patients may not show specific signs or symptoms of upper respiratory tract infection, and the age of onset is similar to that of stroke. Furthermore, an increase in neurological conditions, specifically acute cerebrovascular disease, has been detected. Providing emergency treatment for acute stroke in accordance with the strict epidemic control measures is currently one of the main challenges, as acute stroke is rapid onset and a major cause of death and disability globally. We aimed to evaluate the emergency treatment system for acute stroke during the epidemic control period to provide a reference and basis for informing government and medical institutions on improving patient treatment rates during this period. Methods: Difficulties faced in providing emergency treatment for stroke during an epidemic were investigated and combined with medical educational resources and clinical management experiences to construct an emergency treatment framework for acute stroke during the epidemic. Findings: Currently, emergency treatment measures for acute stroke during the epidemic control period are limited because the main focus is on identifying COVID-19 comorbidities during the critical period. Establishing standards for patients in the neurological outpatient consultation rooms and emergency observation and resuscitation zones; implementing a fast-lane system for the emergency treatment of patients with acute stroke, and strengthening ward management and medicine popularization, can improve the treatment efficiency for stroke patients during the epidemic and provide a reference for peers in clinical practice. Interpretation: Emergency treatment for acute stroke during COVID-19 epidemic control period requires a joint promotion of clinical, popularization, and teaching resources.

5.
J Stroke Cerebrovasc Dis ; 29(12): 105397, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-886527

ABSTRACT

SARS-CoV-2 infection has been associated with ischemic stroke as well as systemic complications such as acute respiratory failure; cytotoxic edema is a well-known sequelae of acute ischemic stroke and can be worsened by the presence of hypercarbia induced by respiratory failure. We present the case of a very rapid neurologic and radiographic decline of a patient with an acute ischemic stroke who developed rapid fulminant cerebral edema leading to herniation in the setting of hypercarbic respiratory failure attributed to SARS-CoV-2 infection. Given the elevated incidence of cerebrovascular complications in patients with COVID-19, it is imperative for clinicians to be aware of the risk of rapidly progressive cerebral edema in patients who develop COVID-19 associated acute respiratory distress syndrome.


Subject(s)
Brain Edema/etiology , Breast Neoplasms/complications , COVID-19/complications , Encephalocele/etiology , Intracranial Hemorrhages/etiology , Stroke/etiology , Aged , Brain Edema/diagnostic imaging , Breast Neoplasms/diagnosis , Breast Neoplasms/drug therapy , COVID-19/diagnosis , Disease Progression , Encephalocele/diagnostic imaging , Female , Humans , Intracranial Hemorrhages/diagnostic imaging , Risk Factors , Stroke/diagnostic imaging
6.
Front Neurol ; 11: 573356, 2020.
Article in English | MEDLINE | ID: covidwho-862010

ABSTRACT

Thromboembolism is a known phenomenon in patients with Coronavirus disease 2019 (COVID-19). Recent investigations have revealed that a significant proportion of those hospitalized with severe COVID-19 demonstrate clinical and laboratory markers compatible with hypercoagulability, which is differentiated from disseminated intravascular coagulation (DIC), termed COVID-associated coagulopathy. Additionally, there is increasing concern for development of acute ischemic stroke because of this hypercoagulable state. We present a patient with COVID-19 pneumonia who was managed with unfractionated heparin (UFH) infusion and developed a large ischemic infarct shortly after cessation of the infusion. In retrospect, the patient's coagulation parameters were consistent with overt DIC, although some of these parameters are easily masked by the effects of UFH. These findings emphasize the importance of anticoagulation as well as its careful discontinuation, as failure to do so may result in a significant thromboembolic event.

7.
BMC Neurol ; 20(1): 358, 2020 Sep 24.
Article in English | MEDLINE | ID: covidwho-792799

ABSTRACT

BACKGROUND: The novel coronavirus (COVID-19) global pandemic is associated with an increased incidence of acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). The treatment of these patients poses unique and significant challenges to health care providers requiring changes in existing protocols. CASE PRESENTATION: A 54-year-old COVID-19 positive patient developed sudden onset left hemiparesis secondary to an acute right middle cerebral artery occlusion (National Institutes of Health Stroke Scale (NIHSS) score = 11). Mechanical thrombectomy (MT) was performed under a new protocol specifically designed to maximize protective measures for the team involved in the care of the patient. Mechanical Thrombectomy was performed successfully under general anesthesia resulting in TICI 3 recanalization. With regards to time metrics, time from door to reperfusion was 60 mins. The 24-h NIHSS score decreased to 2. Patient was discharged after 19 days after improvement of her pulmonary status with modified Rankin Scale = 1. CONCLUSION: Patients infected by COVID-19 can develop LVO that is multifactorial in etiology. Mechanical thrombectomy in a COVID-19 confirmed patient presenting with AIS due to LVO is feasible with current mechanical thrombectomy devices. A change in stroke workflow and protocols is now necessary in order to deliver the appropriate life-saving therapy for COVID-19 positive patients while protecting medical providers.


Subject(s)
Coronavirus Infections/complications , Endovascular Procedures/methods , Infarction, Middle Cerebral Artery/surgery , Personal Protective Equipment , Pneumonia, Viral/complications , Thrombectomy/methods , Betacoronavirus , Brain Ischemia/complications , Brain Ischemia/diagnostic imaging , Brain Ischemia/surgery , COVID-19 , Cerebral Angiography , Computed Tomography Angiography , Emergency Medical Services , Female , Humans , Infarction, Middle Cerebral Artery/complications , Infarction, Middle Cerebral Artery/diagnostic imaging , Intubation, Intratracheal , Middle Aged , Pandemics , Reperfusion , SARS-CoV-2 , Stroke/complications , Stroke/diagnostic imaging , Stroke/surgery , Time-to-Treatment , Treatment Outcome
8.
PLoS One ; 15(9): e0239443, 2020.
Article in English | MEDLINE | ID: covidwho-781671

ABSTRACT

OBJECTIVE: In the setting of the Coronavirus Disease 2019 (COVID-19) global pandemic caused by SARS-CoV-2, a potential association of this disease with stroke has been suggested. We aimed to describe the characteristics of patients who were admitted with COVID-19 and had an acute ischemic stroke (AIS). METHODS: This is a case series of PCR-confirmed COVID-19 patients with ischemic stroke admitted to an academic health system in metropolitan Atlanta, Georgia (USA) between March 24th, 2020 and July 17th, 2020. Demographic, clinical, and radiographic characteristics were described. RESULTS: Of 396 ischemic stroke patients admitted during this study period, 13 (2.5%) were also diagnosed with COVID-19. The mean age of patients was 61.6 ± 10.8 years, 10 (76.9%) male, 8 (61.5%) were Black Americans, mean time from last normal was 4.97 ± 5.1 days, and only one received acute reperfusion therapy. All 13 patients had at least one stroke-associated co-morbidity. The predominant pattern of ischemic stroke was embolic with 4 explained by atrial fibrillation. COVID-19 patients had a significantly higher rate of cryptogenic stroke than non-COVID-19 patients during the study period (69% vs 17%, p = 0.0001). CONCLUSIONS: In our case series, ischemic stroke affected COVID-19 patients with traditional stroke risk factors at an age typically seen in non-COVID populations, and mainly affecting males and Black Americans. We observed a predominantly embolic pattern of stroke with a higher than expected rate of cryptogenic strokes, a prolonged median time to presentation and symptom recognition limiting the use of acute reperfusion treatments. These results highlight the need for increased community awareness, early identification, and management of AIS in COVID-19 patients.


Subject(s)
Betacoronavirus , Brain Ischemia/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/etiology , African Americans , Aged , Atrial Fibrillation/complications , Brain Ischemia/ethnology , Brain Ischemia/virology , COVID-19 , Comorbidity , Coronavirus Infections/ethnology , Disease Management , Early Diagnosis , Embolism/complications , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/ethnology , SARS-CoV-2 , Stroke/ethnology , Stroke/virology
9.
Front Neurol ; 11: 850, 2020.
Article in English | MEDLINE | ID: covidwho-760874

ABSTRACT

Background: COVID-19 has impacted healthcare in many ways, including presentation of acute stroke. Since time-sensitive thrombolysis is essential for reducing morbidity and mortality in acute stroke, any delays due to the pandemic can have serious consequences. Methods: We retrospectively reviewed the electronic medical records for patients presenting with acute ischemic stroke at a comprehensive stroke center in March-April 2020 (the early months of COVID-19) and compared to the same time period in 2019. Stroke metrics such as incidence, time to arrival, and immediate outcomes were assessed. Results: There were 48 acute ischemic strokes (of which 7 were transfers) in March-April 2020 compared to 64 (of which 12 were transfers) in 2019. The average last known well to arrival time (±SD) for stroke codes was 1,041 (±1682.1) min in 2020 and 554 (±604.9) min in 2019. Of the patients presenting directly to the ED with a known last known well time, 27.8% (10/36) presented in the first 4.5 h in 2020, in contrast to 40.5% (15/37) in 2019. Patients who died comprised 10.4% of the stroke cohort in 2020 (5/48) compared to 6.3% in 2019 (4/64). Conclusions: During the first 2 months of COVID-19, there were fewer overall stroke cases who presented to our hospital, and of these cases, there was delayed presentation in comparison to the same time period in 2019. Recognizing how stroke presentation may be affected by COVID-19 would allow for optimization of established stroke triage algorithms in order to ensure safe and timely delivery of stroke care during a pandemic.

10.
AJNR Am J Neuroradiol ; 41(11): 1993-1995, 2020 11.
Article in English | MEDLINE | ID: covidwho-724382

ABSTRACT

We present a radiology-pathology case series of 3 patients with coronavirus disease 2019 (COVID-19) with acute ischemic stroke due to fulminant carotid thrombosis overlying mild atherosclerotic plaque and propose a novel stroke mechanism: COVID-associated carotid atherothrombosis.


Subject(s)
Carotid Artery Diseases/virology , Carotid Artery Thrombosis/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/etiology , Aged , Betacoronavirus , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , Plaque, Atherosclerotic/pathology , Risk Factors , SARS-CoV-2
11.
Front Immunol ; 11: 1648, 2020.
Article in English | MEDLINE | ID: covidwho-685338

ABSTRACT

Cytokine storm is an acute hyperinflammatory response that may be responsible for critical illness in many conditions including viral infections, cancer, sepsis, and multi-organ failure. The phenomenon has been implicated in critically ill patients infected with SARS-CoV-2, the novel coronavirus implicated in COVID-19. Critically ill COVID-19 patients experiencing cytokine storm are believed to have a worse prognosis and increased fatality rate. In SARS-CoV-2 infected patients, cytokine storm appears important to the pathogenesis of several severe manifestations of COVID-19: acute respiratory distress syndrome, thromboembolic diseases such as acute ischemic strokes caused by large vessel occlusion and myocardial infarction, encephalitis, acute kidney injury, and vasculitis (Kawasaki-like syndrome in children and renal vasculitis in adult). Understanding the pathogenesis of cytokine storm will help unravel not only risk factors for the condition but also therapeutic strategies to modulate the immune response and deliver improved outcomes in COVID-19 patients at high risk for severe disease. In this article, we present an overview of the cytokine storm and its implications in COVID-19 settings and identify potential pathways or biomarkers that could be targeted for therapy. Leveraging expert opinion, emerging evidence, and a case-based approach, this position paper provides critical insights on cytokine storm from both a prognostic and therapeutic standpoint.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/drug therapy , Coronavirus Infections/immunology , Critical Care/methods , Cytokines/blood , Pneumonia, Viral/drug therapy , Pneumonia, Viral/immunology , Adrenal Cortex Hormones/therapeutic use , Angiotensin-Converting Enzyme 2 , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , CD4-CD8 Ratio , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , COVID-19 , Clinical Decision-Making/methods , Coronavirus Infections/blood , Coronavirus Infections/mortality , Critical Illness , Endothelial Cells/metabolism , Female , Humans , Immunocompromised Host , Interleukin-6/antagonists & inhibitors , Janus Kinase Inhibitors/therapeutic use , Male , Pandemics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/blood , Pneumonia, Viral/mortality , SARS-CoV-2 , Sex Factors , Thrombosis
12.
Stroke ; 51(8): 2593-2596, 2020 08.
Article in English | MEDLINE | ID: covidwho-680787

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended measures to mitigate the outbreak such as social distancing and confinement. Since these measures have been put in place, anecdotal reports describe a decrease in the number of endovascular therapy (EVT) treatments for acute ischemic stroke due to large vessel occlusion. The purpose of our study was to determine the effect on EVT for patients with acute ischemic stroke during the COVID-19 confinement. In this retrospective, observational study, data were collected from November 1, 2019, to April 15, 2020, at 17 stroke centers in countries where confinement measures have been in place since March 2020 for the COVID-19 pandemic (Switzerland, Italy, France, Spain, Portugal, Germany, Canada, and United States). This study included 1600 patients treated by EVT for acute ischemic stroke. Date of EVT and symptom onset-to-groin puncture time were collected. Mean number of EVTs performed per hospital per 2-week interval and mean stroke onset-to-groin puncture time were calculated before confinement measures and after confinement measures. Distributions (non-normal) between the 2 groups (before COVID-19 confinement versus after COVID-19 confinement) were compared using 2-sample Wilcoxon rank-sum test. The results show a significant decrease in mean number of EVTs performed per hospital per 2-week interval between before COVID-19 confinement (9.0 [95% CI, 7.8-10.1]) and after COVID-19 confinement (6.1 [95% CI, 4.5-7.7]), (P<0.001). In addition, there is a significant increase in mean stroke onset-to-groin puncture time (P<0.001), between before COVID-19 confinement (300.3 minutes [95% CI, 285.3-315.4]) and after COVID-19 confinement (354.5 minutes [95% CI, 316.2-392.7]). Our preliminary analysis indicates a 32% reduction in EVT procedures and an estimated 54-minute increase in symptom onset-to-groin puncture time after confinement measures for COVID-19 pandemic were put into place.


Subject(s)
Coronavirus Infections , Disease Management , Endovascular Procedures/statistics & numerical data , Pandemics , Pneumonia, Viral , Quarantine , Stroke/therapy , Brain Ischemia/therapy , COVID-19 , Eligibility Determination , Female , Humans , Male , Middle Aged , Retrospective Studies , Spain , Time-to-Treatment , Treatment Outcome
13.
J Clin Neurosci ; 79: 80-83, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-639594

ABSTRACT

Coronavirus Disease 2019 (COVID-19) can be associated with various neurological manifestations including acute strokes. Hyper acute diagnosis and treatment are key factors which decrease mortality and morbidity in stroke patients. The COVID-19 pandemic has introduced a great strain on the healthcare system, and as a result clinicians are facing several barriers in diagnosing and treating strokes. Delayed presentation of strokes is a problem as some in the general population defer the decision to seek immediate medical attention fearing contracting the virus. Also playing a role is the paucity of healthcare professionals available during a pandemic. Recent literature demonstrates the association of acute strokes in young patients with COVID-19. Lack of clear pathophysiology of the neurological manifestations from COVID-19 intensifies the problem. A thorough examination of the intensive care unit patient has always been a challenge owing to several factors including use of sedatives, sepsis, uremia, and encephalopathy secondary to medications. Locked-In Syndrome (LIS) secondary to stroke is much more challenging to diagnose as patients are unable to communicate or elicit any motor functions apart from certain ocular movements. We present the case of a 25 year old patient with no known history of coagulopathy, but had developed COVID-19 cytokine storm which culminated in LIS secondary to pontine strokes.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Locked-In Syndrome/etiology , Pneumonia, Viral/complications , Adult , COVID-19 , Female , Humans , Locked-In Syndrome/diagnostic imaging , Pandemics , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/etiology
14.
Stroke ; 51(9): e2111-e2114, 2020 09.
Article in English | MEDLINE | ID: covidwho-636734

ABSTRACT

BACKGROUND AND PURPOSE: Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. METHODS: Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. RESULTS: Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%-46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%-51%), and specifically thrombolysis by 33% (95% CI, 4%-55%), but this finding had less precision. CONCLUSIONS: Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Stroke/complications , Stroke/therapy , COVID-19 , Coronavirus Infections/epidemiology , Humans , Indiana/epidemiology , Kentucky/epidemiology , Ohio/epidemiology , Pandemics , Patient Care Team , Pneumonia, Viral/epidemiology , Prospective Studies , Referral and Consultation/statistics & numerical data , Reperfusion , Stroke/epidemiology , Thrombectomy , Thrombolytic Therapy/statistics & numerical data , Time-to-Treatment , Treatment Outcome
15.
AJNR Am J Neuroradiol ; 41(9): 1677-1682, 2020 09.
Article in English | MEDLINE | ID: covidwho-631034

ABSTRACT

Coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Inflammation affects atherosclerotic plaque vulnerability and promotes a thrombogenic environment. We report a series of 6 patients with COVID-19 with acute ischemic stroke due to intraluminal carotid artery thrombus presenting during an 8-day period. Six patients were included (5 men) with a mean age of 65.8 years (range, 55-78 years). COVID-19 was diagnosed by detection of Severe Acute Respiratory Syndrome coronavirus 2 in 5 patients and was presumed due to typical clinical and imaging findings in 1 patient. All patients had vascular risk factors including diabetes (83%), hyperlipidemia (100%), and smoking (17%). Four patients presented with large infarcts with initial NIHSS scores of 24-30. During their hospitalization, all patients had elevated D-dimer and C-reactive protein levels, 5 patients had elevated lactate dehydrogenase and ferritin levels, 3 had elevated interleukin-6 levels, and 2 had elevated troponin levels. Inflammation related to COVID-19 may result in rupture of vulnerable atherosclerotic plaques, resulting in thrombosis and acute ischemic stroke.


Subject(s)
Betacoronavirus , Brain Ischemia/etiology , Carotid Arteries/diagnostic imaging , Coronavirus Infections/complications , Cytokines/immunology , Pneumonia, Viral/complications , Stroke/etiology , Thrombosis/etiology , Aged , Brain Ischemia/diagnostic imaging , Brain Ischemia/immunology , COVID-19 , Computed Tomography Angiography , Coronavirus Infections/immunology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/immunology , Risk Factors , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/immunology , Thrombosis/diagnostic imaging , Thrombosis/immunology
16.
Diagn Pathol ; 15(1): 78, 2020 Jun 29.
Article in English | MEDLINE | ID: covidwho-617314

ABSTRACT

BACKGROUND: The outbreak of a novel coronavirus since December 2019, became an emergency of major international concern. As of June 21, 2020, the SARS-CoV-2 pandemic has caused 8,769,844 confirmed infections with 463,745 fatal cases worldwide. The SARS-CoV-2 outbreak is a major challenge for clinicians. In our clinic, we found a rare case that a COVID-19 patient combined with ischemic stroke. CASE PRESENTATION: A 79-year-old man was admitted to the Hubei Provincial Hospital of Traditional Chinese Medicine due to right limb weakness for 1 day and slight cough for 1 week. At presentation, his oxygen saturation was 94.2% on room air and body temperature was 37.3 °C (99.0 °F) with some moist rales. Neurological examination showed right limb weakness, and the limb muscle strength was grade 4. The left leg and arms were unaffected. In addition, runs of speech were not fluent enough with tongue deviation. Laboratory studies showed lymphopenia and eosinophilic granulocytopenia. Chest CT revealed bilateral pulmonary parenchymal ground-glass and consolidative pulmonary opacities, with a peripheral lung distribution. Real-time polymerase chain reaction (RT-PCR) from throat swab sample was positive for SARS-CoV-2 nucleic acid. This patient was treated with antiviral drugs and anti-inflammatory drugs with supportive care until his discharge. Clopidogrel (75 mg) and atorvastatin (20 mg) were administered orally to treat acute ischemic stroke. After 12 days of treatment, he can walk normally and communicate with near fluent language. CONCLUSION: We report an even more unusual case, a patient who was hospitalized for right limb weakness and was later diagnosed with COVID-19. Here, SARS-CoV-2 infection caused hypoxemia and excessive secretion of inflammatory cytokines, which contribute to the occurrence and development of ischemic stroke. Once COVID-19 patients show acute ischemic stroke, neurologists should cooperate with infectious disease doctors to help patients.


Subject(s)
Betacoronavirus , Brain Ischemia/virology , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Stroke/virology , Aged , Betacoronavirus/isolation & purification , Brain Ischemia/diagnosis , COVID-19 , COVID-19 Testing , COVID-19 Vaccines , Coronavirus Infections/complications , Humans , Male , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2 , Stroke/diagnosis
17.
Stroke ; 51(8): 2540-2543, 2020 08.
Article in English | MEDLINE | ID: covidwho-418810

ABSTRACT

BACKGROUND AND PURPOSE: Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19. METHODS: All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported. RESULTS: We identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital. CONCLUSIONS: Best medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19.


Subject(s)
Arterial Occlusive Diseases/complications , Brain Ischemia/etiology , Brain Ischemia/therapy , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/etiology , Stroke/therapy , Aged , Arterial Occlusive Diseases/diagnostic imaging , Blood Coagulation Disorders/etiology , Brain/diagnostic imaging , Brain Ischemia/diagnostic imaging , COVID-19 , Cerebral Arteries , Cerebral Veins , Female , Hospital Mortality , Humans , Male , Middle Aged , Pandemics , Plasminogen Activators/therapeutic use , Stroke/diagnostic imaging , Thrombectomy , Thrombolytic Therapy , Time-to-Treatment , Tissue Plasminogen Activator/therapeutic use , Treatment Outcome
18.
J Clin Neurosci ; 77: 234-236, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-272249

ABSTRACT

The 2019 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which was first reported in Wuhan, China last December 2019, has been declared an emergency by the World Health Organization but eventually progressed to become a Pandemic. To date, Coronavirus Disease 2019 (COVID-19) has affected at least 100,000 individuals worldwide, reaching thousands of mortalities (Zhou et al., 2020; World Health Organization, 2020). In the Philippines, the number of COVID-19 confirmed positive cases is over 636 and is expected to rise (Department of Health, 2020). Respiratory infections alongside their comorbidities can induce acute myocardial infarction and acute ischemic stroke (Warren-Gash et al., 2018) [3]. These may further bring challenges in the management and administration of Intravenous (IV) Alteplase in eligible patients. Currently, there are no case reports in the administration IV Altepase in ischemic stroke patients who are COVID-19 positive. We present a case of a 62-year old female who was admitted due to cough, colds and shortness of breath of 2 weeks duration and was tested to be COVD-19 positive. She suffered from an ischemic stroke while in the Medical Intensive Care Unit and was given Intravenous thrombolysis.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/etiology , Thrombolytic Therapy/methods , Administration, Intravenous , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/virology , Female , Humans , Middle Aged , Pandemics , Philippines , Pneumonia, Viral/drug therapy , Pneumonia, Viral/virology , SARS-CoV-2 , Stroke/drug therapy , Stroke/virology , Tissue Plasminogen Activator/administration & dosage , Tissue Plasminogen Activator/therapeutic use
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