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Stroke Care during the COVID-19 Pandemic: International Expert Panel Review.
Venketasubramanian, Narayanaswamy; Anderson, Craig; Ay, Hakan; Aybek, Selma; Brinjikji, Waleed; de Freitas, Gabriel R; Del Brutto, Oscar H; Fassbender, Klaus; Fujimura, Miki; Goldstein, Larry B; Haberl, Roman L; Hankey, Graeme J; Heiss, Wolf-Dieter; Lestro Henriques, Isabel; Kase, Carlos S; Kim, Jong S; Koga, Masatoshi; Kokubo, Yoshihiro; Kuroda, Satoshi; Lee, Kiwon; Lee, Tsong-Hai; Liebeskind, David S; Lip, Gregory Y H; Meairs, Stephen; Medvedev, Roman; Mehndiratta, Man Mohan; Mohr, Jay P; Nagayama, Masao; Pantoni, Leonardo; Papanagiotou, Panagiotis; Parrilla, Guillermo; Pastori, Daniele; Pendlebury, Sarah T; Pettigrew, Luther Creed; Renjen, Pushpendra N; Rundek, Tatjana; Schminke, Ulf; Shinohara, Yukito; Tang, Wai Kwong; Toyoda, Kazunori; Wartenberg, Katja E; Wasay, Mohammad; Hennerici, Michael G.
  • Venketasubramanian N; Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore, drnvramani@gmail.com.
  • Anderson C; The George Institute for Global Health, Camperdown, Washington, Australia.
  • Ay H; Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, USA.
  • Aybek S; Takeda Pharmaceutical Co. Limited, Cambridge, Massachusetts, USA.
  • Brinjikji W; Department of Neurology, University Hospital Inselspital, Bern University, Bern, Switzerland.
  • de Freitas GR; Department of Radiology, Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
  • Del Brutto OH; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil.
  • Fassbender K; Department of Neurology, Universidade Federal Fluminense (UFF), Niterói, Brazil.
  • Fujimura M; School of Medicine, Universidad Espiritu Santo-Ecuador, Samborondón, Ecuador.
  • Goldstein LB; Department of Neurology, Saarland University Medical Centre, Homburg, Germany.
  • Haberl RL; Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
  • Hankey GJ; Division of Advanced Cerebrovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.
  • Heiss WD; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA.
  • Lestro Henriques I; Department of Neurology and Neurological Intensive Medicine, Munich Clinic gGmbH, Academic Teaching Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany.
  • Kase CS; Medical School, The University of Western Australia, Perth, Washington, Australia.
  • Kim JS; Max-Planck-Institut für Neurologische Forschung, Cologne, Germany.
  • Koga M; Department of Neurosciences, Neurology Service, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal.
  • Kokubo Y; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Kuroda S; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
  • Lee K; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
  • Lee TH; Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
  • Liebeskind DS; Department of Neurosurgery, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
  • Lip GYH; Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA.
  • Meairs S; Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
  • Medvedev R; Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA.
  • Mehndiratta MM; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
  • Mohr JP; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
  • Nagayama M; Department of Neurology, Universitätsmedizin Mannheim, Mannheim, Germany.
  • Pantoni L; Research Center of Neurology, Moscow, Russian Federation.
  • Papanagiotou P; Department of Neurology, Janakpuri Super Speciality Hospital, New Delhi, India.
  • Parrilla G; Tananbaum Stroke Center, New York, New York, USA.
  • Pastori D; Department of Neurology, International University of Health and Welfare(IUHW), Graduate School of Medicine, Tokyo, Japan.
  • Pendlebury ST; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
  • Pettigrew LC; Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Germany.
  • Renjen PN; Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
  • Rundek T; Department of Neurology, Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
  • Schminke U; Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
  • Shinohara Y; Departments of Internal Medicine and Geratology, John Radcliffe Hospital, Oxford, United Kingdom.
  • Tang WK; Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, United Kingdom.
  • Toyoda K; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA.
  • Wartenberg KE; Department of Neurosciences, Indraprastha Apollo Hospital, New Delhi, India.
  • Wasay M; Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
  • Hennerici MG; Department of Neurology, University Medicine, Greifswald, Germany.
Cerebrovasc Dis ; 50(3): 245-261, 2021.
Article in English | MEDLINE | ID: covidwho-1147303
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new

setting:

modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions.

SUMMARY:

The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19. Clinicians facing the many etiologies for stroke have been sobered by the unusual incidence of combined etiologies and presentations, prominent among them are vasculitis, cardiomyopathy, hypercoagulable state, and endothelial dysfunction. International standards of acute stroke management remain in force, but COVID-19 adds the burdens of personal protections for the patient, rescue, and hospital staff and for some even into the postdischarge phase. For pending COVID-19 determination and also for those shown to be COVID-19 affected, strict infection control is needed at all times to reduce spread of infection and to protect healthcare staff, using the wealth of well-described methods. For COVID-19 patients with stroke, thrombolysis and thrombectomy should be continued, and the usual early management of hypertension applies, save that recent work suggests continuing ACE inhibitors and ARBs. Prothrombotic states, some acute and severe, encourage prophylactic LMWH unless bleeding risk is high. COVID-19-related cardiomyopathy adds risk of cardioembolic stroke, where heparin or warfarin may be preferable, with experience accumulating with DOACs. As ever, arteritis can prove a difficult diagnosis, especially if not obvious on the acute angiogram done for clot extraction. This field is under rapid development and may generate management recommendations which are as yet unsettled, even undiscovered. Beyond the acute management phase, COVID-19-related stroke also forces rehabilitation services to use protective precautions. As with all stroke patients, health workers should be aware of symptoms of depression, anxiety, insomnia, and/or distress developing in their patients and caregivers. Postdischarge outpatient care currently includes continued secondary prevention measures. Although hoping a COVID-19 stroke patient can be considered cured of the virus, those concerned for contact safety can take comfort in the increasing use of telemedicine, which is itself a growing source of patient-physician contacts. Many online resources are available to patients and physicians. Like prior challenges, stroke care teams will also overcome this one. Key Messages Evidence-based stroke management should continue to be provided throughout the patient care journey, while strict infection control measures are enforced.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Heparin, Low-Molecular-Weight / Stroke / Angiotensin Receptor Antagonists / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Diagnostic study / Etiology study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Heparin, Low-Molecular-Weight / Stroke / Angiotensin Receptor Antagonists / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Diagnostic study / Etiology study / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2021 Document Type: Article