Parkinsonism associated with viral infection

There are several known causes of secondary parkinsonism, the most common being head trauma, stroke, medications, or infections. A growing body of evidence suggests that viral agents may trigger parkinsonian symptoms, but the exact pathological mechanisms are still unknown. In some cases, lesions or inflammatory processes in the basal ganglia or substantia nigra have been found to cause reversible or permanent impairment of the dopaminergic pathway, leading to the occurrence of extrapyramidal symptoms. This chapter reviews current data regarding the viral agents commonly associated with parkinsonism, such as Epstein Barr virus (EBV), hepatitis viruses, human immunodeficiency virus (HIV), herpes viruses, influenza virus, coxsackie virus, and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). We present possible risk factors, proposed pathophysiology mechanisms, published case reports, common associations, and prognosis in order to offer a concise overview of the viral spectrum involved in parkinsonism.

GLOBAL IMPACT OF THE COVID19 PANDEMIC ON SUBARACHNOID HEMORRHAGE ADMISSIONS, ANEURYSM TREATMENT AND IN-HOSPITAL MORTALITY: 1 YEAR FOLLOW-UP

Background: Prior studies indicated a decrease in the incidences of subarachnoid hemorrhage (SAH) during the early stages of the COVID- 19 pandemic. We evaluated differences in the incidence, severity of SAH presentation, and ruptured aneurysm treatment modality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional study including 49 countries and 187 centers. We recorded volumes for: COVID-19 hospitalizations, SAH hospitalizations, Hunt-Hess Grade, coiling, clipping, and aneurysmal SAH (aSAH) in-hospital mortality. Diagnoses were identified by ICD-10 codes or stroke databases from January 2019 to May 2021. Results: Over the study period, there were 16,247 aSAH admissions, 344,491 COVID-19 admissions, 8,300 coiling and 4,240 aneurysmal clipping procedures. Declines were observed in aSAH admissions (-6.4% [95%CI -7,-5.8];p=0.0001) during the first year of the pandemic compared to the prior year, most pronounced in high-volume SAH and highvolume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentation of aSAH (mild: -5%[-5.9,-4.3], p=0.06;moderate: -8.3%[-10.2,-6.7], p=0.06) but no difference in higher SAH severity. The clipping rate remained unchanged (30.7% vs. 31.2%, p=0.58), whereas coiling increased (53.97%vs.56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%,p=0.12). Conclusion: During the first year of the pandemic, there was a decrease in aSAH admissions volume driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the coiling rate, but no change in clipping rate, nor change in aSAH in-hospital mortality.

DIFFERENCES IN MORTALITY RATES IN ISCHEMIC STROKES DURING THE 4 WAVES OF COVID-19

Background: During the COVID-19 pandemic the number of cardioembolic events seem to increase. Mortality in ischemic stroke (IS) patients could be related with this infection. Aim of the study: To assess the mortality rates in IS during the four waves of COVID-19. Methods: Retrospective study, based on Hospital registry of Clinical County Hospital of Braşov, Romania. We evaluated patients with IS and modified Rankin Scale (mRS) score of 6/death at discharge during the first wave (14.03.2020-14.05.2020), the second wave (01.10.2020- 15.01.2021), the third wave (01.03.2021-15.04.2021) and the fourth wave (10.10.2021-20.11.2021). Results: There were 341 patients with IS (46,33% females). For the first wave there were 82 patients (41,46% females), the second wave there were 146 IS patients (47,94% females), the third wave 57 IS patients (42,1% females), and the fourth wave there were 56 IS patients (53,57% females). The total number of patients with mRS score of 6/death having IS was 71: in the first wave 12 patients (14,63%), in the second wave were 27 patients (18,49%), in the third wave 15 patients (26,31%) and in the fourth wave 17 patients (30,35%). Among all patients with IS we identified 79 with COVID-19 and among patients with mRS score of 6/death 23 with COVID-19: i. the first wave 7/1 patients (14,28%);ii. the second wave 43/8 patients (18,6%);iii. the third wave 13/6 patients (46,15%);iv. the fourth wave 16/8 patients (50%). Conclusions: During the four waves evaluated, the mortality in patients with IS COVID-19 negative and positive tends to increase.

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

Increased number of stroke patients and thrombolysis during COVID-19 pandemic

Background and aims: The global pandemic caused by SARS-COV-2, has determined multiple changes in health care systems worldwide. These changes can also be seen in the decreased number of hospitalizations since this pandemic has started. This phenomenon can be caused by the measures taken by health authorities and by the fear of a COVID-19 infection, which discourage some patients to ask for specialized help in emergency departments. Methods: This is a retrospective study in which we compare the number of hospitalizations, strokes and intravenous (IV) thrombolysis performed in our department, during March - December 2020, compared to March - December 2019. Results: Compared to the same period of time of 2019, in 2020 the total number of hospitalizations has decreased with 17.18%. The most considerable decreases were reported in April (39.56%), October (34.37%) and November (35.07%). The number of patients hospitalized due to stroke increased (by 30.38%) between March December 2020, compared to the same period of 2019. Regarding the IV thrombolysis, it was noticed an increase in the number of thrombolysis by 33.54% performed in 2020, compared to the same period of 2019. Conclusion: In our department, the decrease in the number of hospitalizations in April, October and November 2020 compared to the same months of 2019 may be due to the first and second waves of infections and the fear of a nosocomial COVID 19 infection. The number of patients with stroke has increased in 2020 compared to 2019, as well as the number of IV thrombolysis procedure.

The emotional impact of social distancing during the COVID-19 pandemic in Romanian patients with Parkinson's disease

Background and aims: The COVID-19 pandemic has been declared an international public health emergency, considering the various severe consequences on human health. Several restrictive measures (e.g. forced quarantine) were adopted worldwide, including Romania, in order to slow down the transmission of the virus. The aim of this study was to assess the emotional impact of social distancing in Romanian PD patients during COVID-19 pandemic, first wave. Methods: We used an online questionnaire that was distributed on social networks. The questionnaire included questions covering: socio-demographic data, overall impact, level of suffering and feelings of patients with Parkinson's disease (PD). There were 102 respondents. Results: The results of this study suggest that the COVID- 19 pandemic also has a significant emotional impact on people with PD, especially in older people. This is observed in the higher frequency of certain feelings (fear- 70%, frustration- 65%, helplessness- 50%) in people over 50 years of age compared to those under this age (40%, 20%, 20%- for the same feelings). In addition, during this period 44.1% of respondents felt more depressed, 68.6% had sleep problems, 43% experienced a deterioration in health and only 27.5% of participants said that the pandemic did not affect their lives. Regarding the opinion on the social distance measures imposed, 91% of the respondents consider them necessary and 9% consider them exaggerated. Conclusion: The emotional impact of social distancing of PD patients during the COVID-19 pandemic was high. There is need for more strategies to better cope with the negative consequences for mental health.

The emotional impact of social distancing in general Romanian population during COVID-19 pandemic

Background and aims: The recent onset of pandemic with COVID-19 and the social distancing measures had important consequences all over the world, including on the emotional level. The aim of this study was to assess the emotional impact of social distancing in general Romanian population during COVID-19 pandemic. Methods: An online questionnaire was distributed on social networks. The questionnaire comprises 94 questions covering various fields, including socio-demographic data, the overall emotional impact, level of distress and feelings during lockdown. Results: The sample consists of 350 people, of whom 70.6% (n=247) are women. The age of the participants was between 18-74 years. The respondents were asked about the emotional impact of the social distancing measures. We evaluated psychological symptoms such as depression, anxiety, insecurity. The samples' feelings were distributed evenly, as we noticed that one third of the population had low levels of depression, anxiety, fear, agitation, insecurity, confusion. one third of the respondents had also moderate levels and the same percentage of the respondents had high levels of these feelings. Few people felt the same as they did before the pandemic (23.7%), they noticed a change in their appetite (44.6%), but they didn't have trouble sleeping (41.4%) and didn't feel alone (47.4%). Most of them took the chance to spend more time with their loved ones and to develop new hobbies. Conclusion: Social distancing is causing emotional distress at high level in the general population during COVID-19 pandemic.

Prevalence of sleep disturbances in Parkinson's disease patients during the COVID-19 lockdown in Romania

Background and aims: Patients diagnosed with Parkinson's disease (PD) may experience a broad spectrum of sleep disturbances. COVID-19 pandemic and the restrictive measures that were imposed have impacted several aspects of life, including sleep. Objectives: To identify the prevalence of various sleep disorders among PD patients in Romania during the national lockdown period imposed in the context of COVID-19 pandemic. Methods: Prospective online survey on 134 PD patients from the whole Romania. The online survey included items regarding socio-demographic data, various questions related to sleep disorders and the way these sleep disturbances changed during the quarantine period during 16th March - 14th May 2020. Results: There were 74 men (55%), mean age 61.3±5.42 years [range 56-67 years]. Most patients reported at least one sleep disturbances, the most prevalent symptom being insomnia (79.85%), followed by frequent nighttime awakenings (68.65%). The most common sleep complaints that were aggravated during lockdown comparing to baseline were unrefreshing sleep (50.7%), frequent awakenings (19.4%), and sleep initiation difficulties (17.9%). Among the new-onset symptoms occurring during the quarantine, sleep initiation difficulties and early awakenings were the ost commonly reported. The majority of the patients (69.4%) noticed a reduction of the total sleep time during the lockdown. Conclusion: Conclusions: sleep disorders are common in PD patients and most of the sleep-related complaints were aggravated during the lockdown measures.

Sleep quality in romanian PD patients during COVID-19 pandemic

Background and aims: COVID-19 pandemic has serious consequences on general and mental health. The restrictive measures that were proposed in attempt to reduce the spread of the virus were also found to impact various aspects of quality of life. Objectives: To identify if the lockdown period imposed in the context of COVID-19 pandemic has any consequences on sleep quality among Parkinson's disease (PD) patients in Romania. Methods: Prospective online survey on 134 PD patients from the whole Romania. The online survey included items regarding socio-demographic data, various questions related to sleep disorders, standardized rating tools for sleep assessment-Parkinson's Disease Sleep Scale-2 (PDSS-2) and SCOPA sleep. Results: There were 74 men (55%), mean age 61.3±5.42 years. Most patients (68.65%) reported a global worsening of the sleep quality during lockdown comparing to baseline. The most common consequences of the sleep disturbances that occurred during the lockdown were fatigue (59.7%), concentrating difficulties (47.8%), anxiety (35%) and depression (27.6%). According to the patients' opinion, the most common reasons why these sleep disturbances occurred during lockdown were the persistent feelings of fear (44.7%), worrisome thoughts (39.5%) and the lack of physical activity (38.8%). Some patients (31.3%) started to use sleep medication to treat the sleep disturbances that occurred/worsened during the quarantine period. Conclusion: The lockdown measures imposed in the context of COVID-19 pandemic had important negative consequences on quality of sleep in PD patients.