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Acute Cerebrovascular Disease Following COVID-19: A Single Center, Retrospective, Observational Study
... The occurrence of multiple heterogeneous complications associated with Coronavirus disease 2019, SARS-CoV-2 infection, a global pandemic [1,2], has led to several scientific reports and news headlines. Li et al. published one of the first studies describing the risk of stroke among SARS-CoV-2 hospitalized patients [3]. They observed a 5% risk of ischaemic stroke, 0.5% cerebral venous sinus thrombosis, and 0.5% cerebral hemorrhage. ...
... Since the onset of the pandemic, a large population across the globe have been diagnosed with SARS-CoV-2 and several had associated neurological symptoms [11,48À50]. Recently, there has been increasing attention on the vascular complications of SARS-CoV-2, and different pathophysiologic mechanisms have been proposed to underpin such events; among them, one can mention vasoconstriction and increased blood pressure through an imbalance of Angiotensin-Converting Enzyme (ACE) and ACE-2 activation, immunemediated mechanisms and overexpression of the cytokines, vasculitis, and neurological consequences secondary to hypoxemia or hypotension [3,7,8,10,51]. Increased proinflammatory biomarkers [52,53], and COVID-19-associated coagulopathy, characterized by increased fibrinogen/fibrinogen degradation products and D-dimer levels [12À14] were also reported in patients with SARS-CoV-2 infection. ...
... To date, several series of strokes in patients with SARS-CoV-2 diagnoses have been reported [3,4,56]. However, to our knowledge, no prior study has determined the rate of these complications at a multinational level. ...
... However, subsequently increased incidence of strokes (5%-6%) have been reported, more so in moderate to severe COVID. [1][2][3][4][5] In tandem, increased incidence of pulmonary embolism, deep vein thrombosis, and renal arterial thrombi have also been noted. [6,7] This has led to the modification of treatment strategies for patients with moderate and severe disease across the world. ...
... Seven patients had stroke in young, that is, were ≤45 years. Mean NIHSS at stroke onset was 15.2 (range: 3-25), and mean mRS was 4.5 (range: [3][4][5]. Seven patients (38.9%) had been respiratory features of COVID-19, of which five had stroke in the second week, 4-10 days after testing positive for COVID-19. Traditional vascular risk factors for stroke were absent in seven patients and four had hypertension alone. ...
... Compared to the high mortality of up to 38% in COVID strokes, all patients improved remarkably from mean mRS at admission of 4.5 to mean mRS at discharge of 3.1. [1,3] Only 27.8% died, with no age predilection (29-71 years), majority with no or single risk factor but having complete territorial malignant infarcts with brain edema not responding even to surgical decompression. Of the survivors, 69.2% had mRS of ≤2 at 3-month follow-up. ...
Background: An increased incidence of systemic macrothrombotic phenomena such as strokes has been observed in moderate and severe COVID. However, strokes have also been increasingly observed in mild COVID, post-COVID, or without obvious COVID illness.
Objective: To share our experience with a specific stroke type noted during the COVID pandemic period.
Materials and Methods: A single-center observational study was conducted in Western India from January to December 2020, and data regarding stroke patients admitted under Neurology services were noted. Clinical, laboratory, and radiological characteristics of strokes and subtypes were documented.
Results: A total of 238 stroke patients were admitted in 2020, 76.5% during the COVID pandemic period. Among 153 ischemic strokes, 16.3% and 56.2% had large vessel occlusion (LVO) in pre‑COVID and COVID pandemic period, respectively. Of all ischemic strokes, 20.9% (18 patients) and 12% (3 patients) had free floating thrombus (FFT) in the COVID versus pre‑COVID period, respectively. Only 44.4% of all FFT patients
could be proven SARS‑CoV‑2 RT‑PCR positive while 50% were COVID suspect with surrogate markers of heightened inflammation at time of stroke. All patients were given anticoagulation and average mRS at discharge was 3.1 (range: 1–6) and 1.84 (range: 0–4) at 3‑month follow‑up in survivors.
Conclusions: This study highlights the presence of FFT causing LVO as a new stroke subtype during the COVID‑19 pandemic. With renewed and steeper spike in COVID‑19 cases, especially new variants, the resurgence of this stroke subtype needs to be actively explored early in the course of illness to reduce morbidity and mortality.
... Middle Eastern respiratory syndrome coronavirus (MERS-CoV) is another virus like SARS-CoV-2 that emerged in 2012 [6], and MERS-CoV infection leads to multisystemic symptoms, the most lethal component being pneumonia. MERS also can invade the CNS, like SARS-CoV-1 [7]. Genomic studies of SARS-CoV-1, MERS-CoV, and SARS-CoV-2 showed that SARS-CoV-2 has ~79% genetic similarity with SARS-CoV-1 and ~50% similarity with MERS-CoV [8]. ...
... Hypercoagulability, cytokine storm, increased concentration of antiphospholipid antibodies, and abnormal ferritin levels have been suggested to be underlying causes of ischemic stroke in COVID-19 patients [42]. A study found that COVID-19 patients with elevated levels of D-dimer (a marker for ischemic stroke) and C-reactive protein (CRP) in the blood had a greater propensity for mortality [7]. It was also found that patients with acute SARS-CoV-2 infection and neurological symptoms displayed increased interleukin-12 (IL-12) and interleukin-1b (IL-1b) in the CSF [43]. ...
... Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) Version. 22.0 software (IBM Corp., Armonk, NY: USA). The normality of distribution was tested with Shapiro-Wilk for numerical data. ...
... In recent studies, the mean time to onset of stroke after symptoms of COVID-19 was similar. In the study of Li et al. (22), this period was 12 days on average. In another study examining six patients with stroke and COVID-19, patients had a stroke on the 10 th , 24 th , 10 th , 2 nd , 15 th , and 8 th days of the onset of COVID-19 symptoms (23). ...
... An increased risk of stroke was documented after respiratory infections, including influenza, and the risk was highest within the first week [6]. Infection with COVID-19 can also accelerate the progression of acute stroke [7]. A study reported that 16 days after onset of SARS-CoV-2 infection, a 64-year-old man with acute respiratory distress syndrome and a history of atherosclerotic disease developed an ischemic stroke with symptoms of hemiparesis [8]. ...
... In the study of Li and al, the median duration from first symptoms of Covid-19 to cerebrovascular disease were 12 days in eleven patients with severe forms. They were more likely to have cardiovascular risk factors, including hypertension, diabetes and increased inflammatory response [7]. In the cases reported by Tunc and al, the mean time from Covid-19 symptom onset to the diagnosis of stroke was 2 days [9]. ...
... There was a statistically significant association between the prevalence of altered mental status and patient age (mean age = 74 years vs. 60 years) (P = .006). About one-quarter of patients had no known past medical history while the rest had one of the following chronic disorders: hypertension (n = 25, 52.1%); diabetes mellitus (7); coronary artery disease (8); and cerebrovascular disease (9). ...
... Compared with strokes without infection, people were younger, sometimes without cardiovascular risk factors, and the stroke was more often characterized by multiplied cerebral infarcts and caused by occlusion of a large artery. An early emergency thrombectomy is useful for such patients (8)(9)(10)(11)(12)(13). On the other hand, because of the difficult management of these patients, out-of-window recanalization can be assumed, even after >12 h from the onset of symptoms (14). ...
Background:
In the past two decades, three coronavirus epidemics have been reported. Coronavirus disease 2019 (COVID-19) is caused by a severe acute respiratory syndrome (SARS)-like coronavirus (SARS-CoV-2). In most patients, the disease is characterized by interstitial pneumonia, but features can affect other organs.
Purpose:
To document the radiological features of the patients and to perform a narrative review of the literature.
Material and methods:
We conducted a retrospective, single-center study on 1060 consecutive hospitalized patients with COVID-19 at our institution. According to the inclusion criteria, we selected patients to be studied in more radiological detail. All images were obtained as per standard of care protocols. We performed a statistic analysis to describe radiological features. We then presented a systematic review of the main and conventional neuroimaging findings in COVID-19.
Results:
Of 1060 patients hospitalized for COVID-19 disease, 15% (159) met the eligibility criteria. Of these, 16 (10%) did not undergo radiological examinations for various reasons, while 143 (90%) were examined. Of these 143 patients, 48 (33.6%) had positive neuroimaging. We found that the most frequent pathology was acute ischemic stroke (n=16, 33.3%). Much less frequent were Guillain-Barre syndrome (n=9, 18.8%), cerebral venous thrombosis (n=7, 14.6%), encephalitis or myelitis (n=6, 12.5%), intracranial hemorrhage and posterior hemorrhagic encephalopathy syndrome (n=4, 8.3%), exacerbation of multiple sclerosis (n=4, 8.3%), and Miller-Fisher syndrome (n=2, 4.2%).
Conclusion:
Our data are coherent with the published literature. Knowledge of these patterns will make clinicians consider COVID-19 infection when unexplained neurological findings are encountered.
... [2] SARS-CoV-2 has been shown to induce a state of hypercoagulability that predisposes to both arterial and venous thrombotic events. [3] Stroke appears to complicate 0.2% to 5% of SARS-CoV-2 infections, [2,[4][5][6][7] also it remains the second leading cause of death in the world and the third leading cause of death combined with disability. [8] Given early reports of an association between COVID-19 and stroke, there is a critical, unmet need to define the functional outcomes of patients with COVID-19 and stroke, which may help improve their medical care in the future. ...
... The observed rate of imaging-confirmed acute ischemic stroke in hospitalized patients with COVID-19 of 1.44% was comparable with prior reports. [2,[4][5][6][7] However, the initial estimates in Wuhan suggested a higher proportion of ≈5% of acute ischemic stroke among patients hospitalized with SARS-CoV-2 infection. [2] Other cohort studies have reported that the proportion of patients with acute ischemic stroke may range between 1% and 3% among hospitalized COVID-19 patients receiving thromboprophylaxis. ...
We assessed whether stroke severity, functional outcome, and mortality in patients with ischemic stroke differed between patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and those without. We conducted a prospective, single-center cohort study in Irbid, North Jordan. All patients diagnosed with ischemic stroke and SARS-CoV-2 infection were consecutively recruited from October 15, 2020, to October 16, 2021. We recorded demographic data, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, stroke subtype according to the Trial of ORG 10172 in Acute Stroke Treatment Criteria (TOAST), treatments at admission, and laboratory variables for all patients. The primary endpoint was the functional outcome at 3 months assessed using the modified Rankin Score. Secondary outcomes involved in-hospital mortality and mortality at 3 months. We included 178 patients with a mean (standard deviation) age of 67.3 (12), and more than half of the cases were males (96/178; 53.9%). Thirty-six cases were coronavirus disease 2019 (COVID-19) related and had a mean (standard deviation) age of 70 (11.5). When compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a higher median NIHSS score at baseline (6 vs 11; P = .043), after 72 hours (6 vs 12; P = .006), and at discharge (4 vs 16; P < .001). They were also more likely to have a higher median modified Rankin Score after 3 months of follow-up (P < .001). NIHSS score at admission (odds ratio = 1.387, 95% confidence interval = 1.238–1.553]; P < .001) predicted having an unfavorable outcome after 3 months. On the other hand, having a concomitant SARS-CoV-2 infection did not significantly impact the likelihood of unfavorable outcomes (odds ratio = 1.098, 95% confidence interval = 0.270–4.473; P = .896). The finding conclude that SARS-CoV-2 infection led to an increase in both stroke severity and in-hospital mortality but had no significant impact on the likelihood of developing unfavorable outcomes.
... Es la entidad clínica neurológica más frecuentemente descrita, seguramente en relación a la capacidad del virus para afectar el endotelio y activar mecanismos inflamatorios y protrombóticos. Se han hecho reportes de distintas series de pacientes con COVID-19, donde la enfermedad cerebrovascular puede afectar entre el 2 % al 6 % de los pacientes hospitalizados (37,38,39) . La enfermedad cerebrovascular es más común en adultos mayores, con historia de hipertensión arterial, diabetes mellitus o enfermedad vascular cerebral previa (37) . ...
... Se han hecho reportes de distintas series de pacientes con COVID-19, donde la enfermedad cerebrovascular puede afectar entre el 2 % al 6 % de los pacientes hospitalizados (37,38,39) . La enfermedad cerebrovascular es más común en adultos mayores, con historia de hipertensión arterial, diabetes mellitus o enfermedad vascular cerebral previa (37) . Las formas clínicas ubican al infarto cerebral en primer lugar, y mucho menos frecuentemente el accidente isquémico transitorio, la trombosis venosa cerebral y la hemorragia cerebral (27) . ...
Durante el corto tiempo de la presencia de la pandemia causada por la infección del virus SARS-CoV-2 en el mundo, se ha comprobado que un importante número de personas con la COVID-19 presentan diversas complicaciones neurológicas. El virus tiene diversos mecanismos para poder ingresar al sistema nervioso, donde genera lesiones fundamentalmente al alterar el endotelio y el sistema inmune; además el sistema nervioso se afecta por los cambios sistémicos de tipo metabólico, infeccioso, protrombóticos e inmunológicos que se producen en las personas que desarrollan la enfermedad. Los estudios realizados aún de forma no muy sistematizada, muestran que las personas con esta enfermedad, pueden desarrollar síntomas neurológicos diversos como cefalea, mareos, alteración de conciencia, crisis epilépticas, anosmia y también pueden presentar cuadros clínicos neurológicos específicos como enfermedad cerebro vascular, encefalitis, mielitis, encefalitis aguda diseminada, encefalopatía posterior reversible, síndrome de Guillain-Barré. Futuras investigaciones determinarán el daño que el virus puede producir a largo plazo y su asociación a otras entidades neurológicas crónicas como la esclerosis múltiple.
... COVID-19-related IPH is less common than ischemic strokes, but several studies have pointed to an association between COVID-19 and IPH [47][48][49][50]. IPH have been reported in about 0.5% of COVID-19 patients [51]. The proposed mechanisms of IPH in COVID-19 are related to both direct and indirect endothelial toxicity, the former via direct viral endothelial cell invasion and the latter through inflammation that leads to of thrombotic events which ultimately disrupt tight junction protein complexes, Fig. 2 Ischemic strokes in a patient with COVID-19. ...
... Finally, cerebral venous thrombosis (CVT) has been reported in about 0.5% of patients hospitalized with COVID-19 [51]. CVT has been described to affect especially the transverse and sigmoid sinus, with involvement of the deep venous sinus system in about one-third of the cases [63][64][65][66]. ...
Purpose of Review
To describe a comprehensive review of the epidemiology, pathophysiology, and treatment of stroke in the era of COVID-19.
Recent Findings
COVID-19 is associated with myriad neurological disorders, including cerebrovascular disease. While ischemic stroke is the most common, COVID-19 is associated with an increased risk of intracranial hemorrhage, arterial dissection, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis. In this review, we discuss the epidemiology, pathophysiology, and treatment of stroke due to COVID-19. In addition, we describe how COVID-19 has changed the landscape of stroke systems of care and the effect this has had on patients with cerebrovascular disease.
Summary
While COVID-19 is associated with a heightened risk of stroke, the pandemic has led to advances in stroke systems of care that may reduce the long-term burden of stroke.
... These patients were also more likely to present cardiovascular risk factors, including hypertension (69.2% vs. 22.1%), diabetes (46.2% vs. 12.0%), and previous medical history of cardiocerebrovascular diseases (23.1% vs. 6.7%). [6] Considering this scenario, this study aimed to assess the frequency and severity of neurological manifestations as well as putative risk factors of COVID-19-positive patients in the city of Makkah, Saudi Arabia. ...
Background: Coronaviruses are the important pathogens of humans and animals that can cause diseases ranging from the common cold to more severe or even fatal respiratory infections. Regarding nervous system complications, existing literature has revealed increasing reports of neurological manifestations in coronavirus disease 2019 (COVID-19)-positive patients ranging from mild-to-severe manifestations. Aim: In this study, we aimed to determine the prevalence of neurological manifestations in COVID-19-positive patients. Furthermore, we sought to ascertain the most common and most severe manifestations and to find the significant associations with laboratory or clinical findings. Setting and Design: This is a retrospective cross-sectional observational study that was conducted at two centers. Materials and Methods: Patient data were collected in periods from of March 1 to of July 30, 2020 labeled as the first wave, and from December 1, 2021 to January 30, 2022 labeled as the second wave in two tertiary care hospitals, Al-Noor Specialist Hospital and King Abdullah Medical City, situated in Makkah city, Saudi Arabia. The study included patients who were ≥ 18 years of age and were found to have any neurological manifestations and/or complications secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study was conducted in different periods to assess the different waves of the COVID-19 pandemic and to allow the comparison between them. Results: From a total number of 4751 patients with confirmed SARS-CoV-2 infection eligible during the periods included in our study, we found neurological manifestations in 263 patients, particularly 229 from the first wave and 34 from the second wave. In the first wave patients, 102 (44.5%) were aged between 18 and 39 years of age. The prevalence of neurological manifestations was 6.4% in the first wave and 2.9% in the second wave. Conclusion: Our study showed a large variety of neurological manifestations in COVID-19-positive patients. The most common neurological manifestations were headache and impaired level of consciousness, whereas the most severe conditions were cerebrovascular events, seizure, encephalopathy, and brain death.
... Инфекцията със SARS-CoV-2 е рисков фактор за развитието на инсулт -исхемичен или хеморагичен. От 2.5 до 6% от хоспитализираните пациенти с COVID-19 се диагностицират с инсулт (9). Повечето от тях са с исхемични инсулти, единични са с хеморагии и синусови венозни тромбози. ...
Clinical studies have shown that SARS-CoV-2 demonstrated neurotropic potential and may induce acute neurological manifestations, various neurological complications and long-term neurocognitive sequelae. In Coronavirus disease 2019 (COVID-19) have been described vascular and inflammatory involvement of central and peripheral nervous system. Most patients with COVID-19 have reported at least one neurological symptom and have an altered mental status. The severe course of the disease, requiring Intensive care unit (ICU) admission, has been associated with prolonged neurological dysfunction.
... 68 , and cerebrovascular disease. 69,70 Laboratory features of Covid-19 include neutrophilia, 22 lymphopenia, thrombocytopenia, 71 raised serum levels of C-reactive protein (CRP), procalcitonin, D-dimer, fibrinogen, ferritin, 65,66 creatinine, and urea. 64,65 There may be residual renal dysfunction, such as minor elevation in creatinine and urea after Covid-19. ...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a deadly pneumonia caused by an enveloped, single-stranded RNA betacoronavirus belonging to the coronaviridae family. Pathophysiologically, SARS-CoV-2 is due to severe hyperinflammatory host response to the coronavirus, resulting in overproduction of cytokines, chemokines, and growth factors by macrophages, such as interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-10, and tumour necrosis factor-α. SARS-CoV-2 is characterized by diffuse alveolar damage due to direct infection of alveolar type II pneumocytes, pulmonary edema, vascular occlusion, interstitial infiltrates, and ventilation/perfusion mismatch, which rapidly progress to hypoxemia, acute respiratory distress syndrome, multi-organ failure, and death. The standard of care of Covid-19, includes high-flow nasal oxygen (HFNO), dexamethasone, remdesivir, and mechanical ventilation or extracorporeal membrane oxygenation in very severe cases. However, the mortality is exceptionally high even with these therapies. Covid-19 is due to dysregulation, and over-production of cytokines, including IL-1β, IL-6, IL-10, and TNF-α. IL-6 plays a key role in orchestrating the hyperinflammation and the cytokine storm, which leads to acute lung injury, respiratory failure, and multi-organ failure. Interleukin-6 signaling is via the transmembrane IL-6 receptor-α (mIL-6Rα), and the soluble IL-6Rα. Tocilizumab, and sarilumab are IL-6Rα antagonists, and have been issued an emergency use authorization (EUA) by the FDA. Both biologics are safe, and effective in the treatment of severe Covid-19, particularly in patients requiring HFNO, and respiratory support. Another therapeutic approach to treat Covid-19 is to target the downstream JAK/STAT pathway which plays a critical role in inciting IL-6 immunopathological effects. Baricitimab and tofacitinib have been granted EUA by the FDA. A systemic review has shown that JAK-inhibitors significantly decrease odd of mortality (P ˂ 0.0005), and ICU admission (P ˂ 0.0005). Additionally JAKinibs significantly increase odds for patient discharge within 2 weeks P ˂ 0.00001). Tofacitinib has been reported to lead to a lower risk of respiratory failure or death through day 28 than placebo in hospitalized patients with Covid-19. Barictinib in addition to standard of care, including dexamethasone was associated with reduced mortality in hospitalized adults with Covid-19. Selective JAK inhibitors in addition to usual care are effective in the treatment of patients with Covid-19.
... Although the incidence of AIS in patients with acute COVID-19 is not as high as initially thought [26], it has been consistently reported to range from approximately 1% (France) [27] to 1.6% (USA) [3,28] in all patients with COVID-19 (1.26% in this study) matching the frequency demonstrated here. Cho and co-workers [29] reported 1.5% in-hospital strokes (worldwide) as a complication, although this number was not broken down by AIS and IH. ...
Background
Coronavirus disease 2019 (COVID-19) is an infection which can affect the central nervous system. In this study, we sought to investigate associations between neuroimaging findings with clinical, demographic, blood and cerebrospinal fluid (CSF) parameters, pre-existing conditions and the severity of acute COVID-19.
Materials and methods
Retrospective multicenter data retrieval from 10 university medical centers in Germany, Switzerland and Austria between February 2020 and September 2021. We included patients with COVID-19, acute neurological symptoms and cranial imaging. We collected demographics, neurological symptoms, COVID-19 severity, results of cranial imaging, blood and CSF parameters during the hospital stay.
Results
442 patients could be included. COVID-19 severity was mild in 124 (28.1%) patients (moderate n = 134/30.3%, severe n = 43/9.7%, critical n = 141/31.9%). 220 patients (49.8%) presented with respiratory symptoms, 167 (37.8%) presented with neurological symptoms first. Acute ischemic stroke (AIS) was detected in 70 (15.8%), intracranial hemorrhage (IH) in 48 (10.9%) patients. Typical risk factors were associated with AIS; extracorporeal membrane oxygenation therapy and invasive ventilation with IH. No association was found between the severity of COVID-19 or blood/CSF parameters and the occurrence of AIS or IH.
Discussion
AIS was the most common finding on cranial imaging. IH was more prevalent than expected but a less common finding than AIS. Patients with IH had a distinct clinical profile compared to patients with AIS. There was no association between AIS or IH and the severity of COVID-19. A considerable proportion of patients presented with neurological symptoms first. Laboratory parameters have limited value as a screening tool.
... Mortality occurred in 32.1% of cases, and the median mRS was 4 at discharge [IQR: 2-6]. Life-prolonging interventions were discontinued in 24.0% of all cases, median length of stay was 11 days [IQR: [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], and in-hospital complications occurred in 27.0%. Most frequent discharge disposition was home (40.4%) followed by acute inpatient rehabilitation centers (27.9%). ...
Objectives:
The COVID-19 pandemic has heightened awareness of health disparities associated with socioeconomic status (SES) across the United States. We examined whether household income is associated with functional outcomes after stroke and COVID-19.
Materials and methods:
This was a multi-institutional, retrospective cohort study of consecutively hospitalized patients with SARS-CoV-2 and radiographically confirmed stroke presenting from March through November 2020 to any of five comprehensive stroke centers in metropolitan Chicago, Illinois, USA. Zip-code-derived household income was dichotomized at the Chicago median. Logistic regression was used to examine the relationship between household income and good functional outcome (modified Rankin Scale 0-3 at discharge, after ischemic stroke).
Results:
Across five hospitals, 159 patients were included. Black patients comprised 48.1%, White patients 38.6%, and Hispanic patients 27.7%. Median household income was $46,938 [IQR: $32,460-63,219]. Ischemic stroke occurred in 115 (72.3%) patients (median NIHSS 7, IQR: 0.5-18.5) and hemorrhagic stroke in 37 (23.7%). When controlling for age, sex, severe COVID-19, and NIHSS, patients with ischemic stroke and household income above the Chicago median were more likely to have a good functional outcome at discharge (OR 7.53, 95% CI 1.61 - 45.73; P=0.016). Race/ethnicity were not included in final adjusted models given collinearity with income.
Conclusions:
In this multi-institutional study of hospitalized patients with stroke, those residing in higher SES zip codes were more likely to have better functional outcomes, despite controlling for stroke severity and COVID-19 severity. This suggests that area-based SES factors may play a role in outcomes from stroke and COVID-19.
... This is widely supported by the fact that COVID-19 patients express higher levels of factor VIII, fibrinogen, and D-dimer, which are directly involved in clot formation [8,11]. In a retrospective study, 13 patients of the observed 219 participants developed cerebrovascular disorders, and 11 of them experienced cerebrovascular accidents including ten ischemic strokes and one intracerebral hemorrhage [12]. Moreover, case studies have reported an associated increase in the prevalence of large vessel occlusion stroke in COVID-19 patients [4]. ...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects multiple body systems, including the nervous system. Cerebrovascular accidents can also occur. Patients with comorbid illnesses have severe manifestations and poor outcomes. Despite the proper mechanism of SARS-CoV-2 infection-associated stroke having not yet been settled, various possible mechanisms have been hypothesized. One possibility is that the virus causes endothelial dysfunction and immune-mediated injury. Another possibility is that the trans-neuronal spread of the virus affects brain tissue. In addition, hypercoagulability caused by SARS-CoV-2 infection could lead to a stroke. A virus-induced dysfunction of the renin-angiotensin system could also lead to a stroke. The immune response and vasculitis resulting from SARS-CoV-2 infection are also possible causes via a cytokine storm, immune dysfunction, and various inflammatory responses. SARS-CoV-2 infection may affect calcitonin gene-related peptides and cerebral blood flow and may lead to stroke. Finally, SARS-CoV-2 may cause hemorrhagic strokes via mechanisms stimulated by its interaction Correspondence to: Abdulqadir J. Nashwan, anashwan@hamad.qa with angiotensin-converting enzyme 2 (ACE2), leading to arterial wall damage and blood pressure changes. In this article, we will present seven cases of stroke-associated SARS-CoV-2 infection.
... По данным Li с соавт. [39], существенно возросла частота ишемических инсультов по атеротромботическому типу, геморрагические инсульты регистрировались реже [10]. Было отмечено, что сосудистые поражения головного мозга, не имели прямой корреляции с размером кровеносного сосуда [45]. ...
The coronavirus infection, COVID-19, caused by SARS-CoV-2 is associated not only with a wide range of respiratory syndromes, but also with a pronounced destructive effect on the blood vessels of the whole body. Age and concomitant pathology predispose to a more severe course of the disease. Endothelial damage, widespread vasculitis and thrombosis can be distinguished as general nonspecific pathomorphological changes developing in blood vessels under the influence of SARS-CoV-2. For the blood vessels of the lungs, in addition to alteration of the endothelium and thrombosis, angiogenesis of the cleaving (invagination) type was typical. The general mechanism of alteration of blood vessels and the development of vasculopathy is the direct cytopathic effect of the virus on endotheliocytes and immune-mediated damage to the endothelium, manifested by the development of endotheliitis, destruction of intercellular contacts of endothelial cells, their swelling and separation from the basement membrane, accompanied by endo- and perivascular inflammation. Molecular biological mechanisms of virus invasion involve various ways of its penetration into the cell and various forms of development of the inflammatory response with the participation of innate and acquired immunity reactions.
... Thromboembolic manifestations, specifically stroke [19], have been described with the disease, being more frequent in the late stages of it and seem to share a connection with D-dimer, hypercoagulability, cytokine release syndrome and the infection's gravity. Five cases of young patients with large vessel stroke in New York, with no vascular risk factors history, are published in NEJM [20]. ...
... [14] Li et al. have reported the occurrence of stroke in the initial phase of infection. [15] In various cases, Guillain-Barré syndrome has been reported after the episode of COVID-19. [16][17][18] Another organ system that can be affected by the intricate and complex mechanism of COVID-19 is the renal system. ...
... D-dimer dan CRP ditemukan lebih tinggi pada pasien stroke, menandakan keadaan hiperinflamasi dan hiperkoagulan yang mungkin berperan dalam kasus stroke pada COVID-19. 37 Mao et al., melaporkan insiden stroke iskemik sebesar 5.7% pada 78 pasien COVID-19 berat. 38 Kejadian trombosis juga dapat mengenai arteri perifer. ...
Background: Nowadays, the transmission of HIV-AIDS is mostly due to risky sexual activity and found in the heterosexual group, around 76.5%. The high rate may be due to stigma and discrimination in society, so risk people are reluctant to come for a check-up or treatment. This study aims to evaluate the comprehensive approach from the upstream to downstream and culture based in dealing with HIV-AIDS in the form of Mobile Voluntary Counseling Testing (VCT) that has been carried out by the Indonesian Planned Parenthood Association (IPPA) Bali, Indonesia.Methods: This descriptive cross sectional study was conducted in the 2016-2018 period in all regions of Bali, Indonesia, by convenience sampling technique. There are differences in the total number of services that have been performed which include Post-Test (+) counselling, Post-Test Counseling (-), rapid test evaluation, HIV counselling and prevention measures, as well as VCT Pre-Test counselling. The medical team and counsellor came together to meet directly with groups at risk of HIV-AIDS infection called key populations, such as commercial sex workers, transvestites, drug users, and homosexuals. The data obtained were analyzed descriptively using Microsoft Excel for Windows.Results: The results of this descriptive empirical study show that the overall Post-Test (+) counselling was conducted 9 times in 2016 (2 times), 2017 (3 times), and 2018 (4 times). Whereas in Post-Test (-) counselling there were 161 examinations in 2016, 105 times (2017), and 125 (2018). In the last 3 years, 1,472 investigations have been carried out, of which 652 times were in 2016, 367 times in 2017, and 453 times in 2018.Conclusion: Mobile VCT of IPPA Bali may be one of the effective efforts in responding to the challenges of people who tend to be taboo and less concerned about sexual and reproductive health issues. Latar Belakang: Saat ini penularan HIV-AIDS sebagian besar disebabkan oleh aktivitas seksual yang berisiko dan ditemukan pada kelompok heteroseksual sekitar 76,5%. Tingginya angka tersebut mungkin disebabkan oleh stigma dan diskriminasi di masyarakat, sehingga orang yang berisiko enggan datang untuk melakukan pemeriksaan atau perawatan. Penelitian ini bertujuan untuk mengevaluasi pendekatan komprehensif dari hulu ke hilir dan budaya berbasis dalam berurusan dengan HIV-AIDS dalam bentuk Pengujian Konseling Sukarela Seluler (VCT) yang telah dilakukan oleh PKBI Bali, Indonesia.Metode: Penelitian deskriptif dengan pendekatan potong lintang ini dilakukan dalam rentang periode 2016-2018 di seluruh daerah Bali, Indonesia dengan menggunakan teknik convenience sampling. Terdapat perbedaan jumlah total layanan yang telah dilakukan dimana meliputi konseling Post-Test (+), Konseling Post-Test (-), evaluasi rapid test, konseling HIV dan tindakan pencegahan, maupun konseling VCT Pre-Test. Tim medis dan konselor datang bersama untuk bertemu langsung dengan kelompok yang berisiko terinfeksi HIV-AIDS yang disebut populasi kunci, seperti pekerja seks komersial, waria, pengguna narkoba, dan homoseksual. Data yang diperoleh dianalisis secara deskriptif menggunakan Microsoft Excel untuk Windows.Hasil: Hasil studi empiris deskriptif ini menunjukkan bahwa telah dilakukan 9 kali konseling Post-Test (+) baik pada tahun 2016 (2 kali), 2017 (3 kali), dan 2018 (4 kali). Sedangkan pada konseling Post-Test (-) terdapat 161 kali pemeriksaan pada tahun 2016, 105 kali (2017), dan 125 (2018). Secara keseluruhan dalam 3 tahun terakhir telah dilakukan sebanyak 1.472 pemeriksaan dimana sebanyak 652 kali pada tahun 2016, 367 kali pada tahun 2017, dan 453 kali pada tahun 2018.Kesimpulan: Mobile VCT PKBI Bali dapat menjadi salah satu upaya efektif dalam menanggapi tantangan orang-orang yang cenderung tabu dan kurang peduli tentang masalah kesehatan seksual dan reproduksi.
... 45 Although the interval between positive neuroimaging after SARS-CoV-2 infection is not clear in the literature, Li et al. reported it as about 12 days. 46 In our study, the median time between the first positive RT-PCR and the first positive neuroimaging was 22.24 days (IQR: 4.44-141.23, p=0.023). ...
Objectives
We aimed to determine the incidences of neuroimaging findings (NIF) and investigate the relationship between the course of pneumonia severity and neuroimaging findings.
Materials and Methods
Our study was a retrospective analysis of 272 (>18 years) COVID-19 patients who were admitted between “March 11, 2021, and September 26, 2022". All patients underwent both chest CT and neuroimaging. The patient's chest CTs were evaluated for pneumonia severity using a severity score system (CT-SS). The incidence of NIF was calculated. NIF were categorized into two groups; neuroimaging positive (NIP) and neuroimaging negative (NIN). Consecutive CT-SS changes in positive and negative NIF patients were analyzed.
Results
The median age of total patients was 71; IQR, 57-80. Of all patients, 56/272 (20.6%) were NIP. There was no significant relationship between NIP and mortality (p= 0.815) and ICU admission (p= 0.187). The incidences of NIF in our patients were as follows: Acute-subacute ischemic stroke: 47/272 (17.3%); Acute spontaneous intracranial hemorrhage: 13/272 (4.8%); Cerebral microhemorrhages: 10/272 (3.7%) and Cerebral venous sinus thrombosis: 3/25 (10.7%). Temporal change of CT-SSs, there was a statistically significant increase in the second and third CT-SSs compared to the first CT-SS in both patients with NIP and NIN.
Conclusion
Our results showed that since neurological damage can be seen in the late period and neurological damage may develop regardless of pneumonia severity.
... Cerebrovascular disease has been identified as part of the COVID-19 spectrum. Ischemic stroke has been reported in almost 5% of cases, cerebral venous thrombosis in 0.5%, and hemorrhagic stroke (HS) in 0.5% [1][2][3] . Debate has emerged between whether there is a casual or causal relationship between HS and SARS-CoV-2 infection. ...
Objective:
The objective of this study was to determine if there are differences between the presentation patterns of hemorrhagic stroke (HS) associated to COVID-19.
Methods:
It was performed a systematic search based on PRISMA guidelines of the cases reported in PUBMED of HS associated to SARS-CoV-2 infection and we added to this sample cases from our own hospital cohort. Patients in the database were separated by groups according to presentation symptoms: if they debuted with neurological symptoms or debuted with pulmonary symptoms.
Results:
Seventy cases were included in the study. Patients that debuted with pulmonary symptoms accounted for 68.6% of the cases with an interval between the development of symptoms and the presentation of HS of 15.6 days. We found that the use of anticoagulants during hospitalization, multifocal image pattern, and the elevation of D-dimer, Ferritin, and lactate dehydrogenase levels were significantly associated with the group of pulmonary presentation, whereas the presence of hypertension during hospitalization, and a lower hemoglobin level was associated with the group of neurologic symptoms.
Conclusion:
Although HS associated with COVID-19 is a clinical entity with increasing evidence, it is necessary to establish that there are two forms of presentation with their own characteristics.
... However, compared to dyspnea and cough, which are both frequent pulmonary symptoms, neurological dysfunctions were much less prevalent. In a study on 221 individuals, Li et al. found that SARS-CoV-2 causes more serious and potentially long-term neurological problems, and 6% experienced severe neurological illness, including ischemic stroke, bleeding from cerebral vein thrombosis, and death as consequences [137,154]. ...
It is considered that COVID-19's pandemic expansion is responsible for the particular increase in deaths, especially among the population with comorbidities. ,e health system is often overwhelmed by the large number of cases of patients addressing it, by the regional limitation of funds, and by the gravity of cases at subjects suffering from this pathology. Several associated conditions including diabetes, cardiovascular illnesses, obesity, persistent lung condition, neurodegenerative diseases, etc., increase the mortality risk and hospitalization of subjects suffering from COVID-19. ,e rapid identification of patients with increased risk of death from the SARS-CoV-2 virus, the stratification in accordance with the risk and the allocation of human, financial, and logistical resources in proportion must be a priority for health systems worldwide.
... Another study reported that lymphocyte and platelet levels were lower in COVID-19 patients with central nervous system (CNS) involvement compared to those without (12). However this study was not conducted in intensive care patients. ...
Introduction: Although COVID-19 disease often includes respiratory system findings, that affects the gastrointestinal system, circulatory system, coagulation system and neurological system. In this study, we identified the neurological signs and symptoms observed in critical COVID-19 patients. Material and Method: This retrospective study reviewed 595 COVID-19 patients admitted to our intensive care unit (ICU) between January to June 2020. Patients with neurologic symptoms that were divided into two groups were diagnosed neurological disease (group ND) and non-neurological disease (group non-ND). Clinical signs and symptoms, radiological findings, demographic data (age, gender, presence of comorbidities), white blood cell (WBC), lymphocyte, platelet, lactic acid, glucose, and D-dimer levels, length of hospitalization, requirement of mechanical ventilation, and mortality were recorded for each patient. Results: Neurologic symptoms were observed in 148 (24.8%) patients. Of these, 44 patients were diagnosed neurological disease and 104 patients were non- neurological disease. The prevalence of neurologic symptoms was significantly higher in group ND. The rate of acute ischemic cerebrovascular disease in 595 critical COVID-19 patients was 6.2%. Conclusion: Presence of cerebrovascular diseases should be suspected in COVID-19patients with paresis, altered consciousness, numbness, taste/smell disorders, and plegia. The rate of ischemic cerebrovascular disease was approximately seven times higher than the rate of hemorrhagic cerebrovascular disease in critically COVID-19 patients.
... Постковідний синдром виявляється у високій тривожності, розвитку панічних атак. Нерідко синдром проявляється тремором кінцівок, збільшенням частоти серцевих скорочень, розвитком гіпертонії, загальною слабкістю, порушенням церебрального кровообігу 8,9,10,11 . Отже, необхідність подальшого дослідження зазначених симптомів виходить на перший план. ...
... [7] Concerning ischaemic stroke in patients with COVID-19, a frequency of 2.5% was reported from Italy, [20] while a higher frequency of 5% has been reported from China. [21] We observed ischaemic stroke in 2.2% of the patients in our study population. The lower incidence here could be the result of the overall younger age of the cohort. ...
Introduction: Coronavirus disease 2019 (COVID-19), the disease linked to severe acute respiratory syndrome coronavirus-2, is a widespread infectious disease. Coronaviruses cause multiple systemic infections, but neurological involvement has been reported very rarely. Materials and Methods: The present study is a single-centre prospective study conducted during the COVID-19 pandemic from November 2020 to April 2021, at Mogamedicity Superspeciality Hospital, Punjab, India. All COVID-19 patients with de novo neurologic manifestations were eligible to take part in the study. A total of 810 confirmed COVID-19 patients were enrolled for the study. Demographic features and initial clinical manifestations were noted, and patients were followed up during the hospital stay for the development of any new neurological signs and symptoms. For analytical purposes, neurological presentations were grouped into the central nervous system, peripheral nervous system and musculoskeletal system manifestations. Appropriate laboratory testing was employed as required on a case-to-case basis. Results: In this study, the mean age of the patients was 46.6 ± 15.5 years. Five hundred and fifty two (66.9%) patients were male, while 268 (33.1%) were female. Neurological illness was a primary manifestation in 48 (6%) cases. These included encephalopathy (n = 30), ischaemic stroke (n = 4), Guillain–Barre syndrome, (n = 2), facial nerve palsy (n = 4) and encephalitis (n = 1). The most common neurological symptoms were headache (284 [35%]) and hyposmia (78 [9.6%]), followed by encephalopathy (68 [8.3%]). More serious complications such as seizures (14 [0.7%]) and stroke (18 [2.2%]) were also seen. Conclusion: COVID-19 can present with a neurological illness, and we should remain vigilant to the possibility of neurological presentation of COVID-19 that can be thrombo-embolic, inflammatory or immune-mediated.
... This hypercoagulable state can cause blood clots in both the cerebral arteries and veins, resulting in stroke and cerebral venous thrombosis. [35] In a study done at Columbia University, where an autopsy was performed on 41 patients who died of COVID, it was found that there was no evidence of viral RNA or protein in the brain cells but there were evident signs of hypoxic brain death. The authors contradict the direct neuroinvasion by SARS-CoV-2 and postulated that these hypoxic lesions are a consequence of thromboembolic events that are secondary to COVID infection and it is hypoxia responsible for the neurological signs of COVID. ...
The current pandemic has affected almost everyone worldwide. Although the majority of people survive the illness, bad cognitive repercussions might last a long time, resulting in a lower quality of life and disability, particularly in severe cases. We tried to understand and bring together the various possible mechanisms leading to dementia in COVID-19. The link between COVID-19 and dementia will help public health workers plan and allocate resources to provide better care for a community suffering from sickness and improve quality of life. A conceptual framework for care of infected people in the older age group and care of dementia people is proposed.
... The copyright holder for this preprint this version posted August 4, 2022. ; https://doi.org/10.1101/2022.08.03.22278392 doi: medRxiv preprint infarction, stroke, deep vein thrombosis, arterial thrombosis, or pulmonary embolism [30][31][32][33] . Second, the proposed protective effect might be from the antiviral properties of ASA which has previously been shown for viruses of H1N1, MERS-CoV, and CoV-229E 3,13,34 . ...
Background/Objectives
Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state and increased thrombotic risk in infected individuals. Several complex and varied coagulation abnormalities were proposed for this association ¹ . Acetylsalicylic acid(ASA, aspirin) is known to have inflammatory, antithrombotic properties and its use was reported as having potency to reduce RNA synthesis and replication of some types of coronaviruses including human coronavirus-299E (CoV-229E) and Middle East Respiratory Syndrome (MERS)-CoV 2,3 . We hypothesized that chronic low dose aspirin use may decrease COVID-19 mortality relative to ASA non-users.
Methods
This is a retrospective, observational cohort analysis of residents residing at Veterans Affairs Community Living Centers from December 13, 2020, to September 18, 2021, with a positive SARS-CoV-2 PCR test. Low dose aspirin users had low dose (81mg) therapy (10 of 14 days) prior to the positive COVID date and were compared to aspirin non-users (no ASA in prior 14 days). The primary outcome was mortality at 30 and 56 days post positive test and hospitalization.
Results
We identified 1.823 residents who had SARS-CoV-2 infection and 1,687 residents were eligible for the study. Aspirin use was independently associated with a reduced risk of 30 days of mortality (adjusted HR, 0.60, 95% CI, 0.40-0.90) and 56 days of mortality (adjusted HR, 0.67, 95% CI, 0.47-0.95)
Conclusion
Chronic low dose aspirin use for primary or secondary prevention of cardiovascular events is associated with lower COVID-19 mortality. Although additional randomized controlled trials are required to understand these associations and the potential implications more fully for improving care, aspirin remains a medication with known side effects and clinical practice should not change based on these findings.
... Concerning hemorrhagic stroke, the prevalence we found (3.0%; with ICH 1.8%, and SAH 1.2%) was higher compared to most previous studies in broader hospitalized COVID-19 cohorts [33][34][35][36]. Yet, Kleineberg et al. [7] reported a prevalence of even 5% in patients at the critical stage. ...
Background:
Neurologic manifestations are increasingly reported in patients with coronavirus disease 2019 (COVID-19). Yet, data on prevalence, predictors and relevance for outcome of neurological manifestations in patients requiring intensive care are scarce. We aimed to characterize prevalence, risk factors and impact on outcome of neurologic manifestations in critically ill COVID-19 patients.
Methods:
In the prospective, multicenter, observational registry study PANDEMIC (Pooled Analysis of Neurologic DisordErs Manifesting in Intensive care of COVID-19), we enrolled COVID-19 patients with neurologic manifestations admitted to 19 German intensive care units (ICU) between April 2020 and September 2021. We performed descriptive and explorative statistical analyses. Multivariable models were used to investigate factors associated with disorder categories and their underlying diagnoses as well as to identify predictors of outcome.
Results:
Of the 392 patients included in the analysis, 70.7% (277/392) were male and the mean age was 65.3 (SD ± 3.1) years. During the study period, a total of 2681 patients with COVID-19 were treated at the ICUs of 15 participating centers. New neurologic disorders were identified in 350 patients, reported by these centers, suggesting a prevalence of COVID-19-associated neurologic disorders of 12.7% among COVID-19 ICU patients. Encephalopathy (46.2%; 181/392), cerebrovascular (41.0%; 161/392) and neuromuscular disorders (20.4%; 80/392) were the most frequent categories identified. Out of 35 cerebrospinal fluid analyses with reverse transcriptase PCR for SARS-COV-2, only 3 were positive. In-hospital mortality was 36.0% (140/389), and functional outcome (mRS 3 to 5) of surviving patients was poor at hospital discharge in 70.9% (161/227). Intracerebral hemorrhage (OR 6.2, 95% CI 2.5-14.9, p < 0.001) and acute ischemic stroke (OR 3.9, 95% CI 1.9-8.2, p < 0.001) were the strongest predictors of poor outcome among the included patients.
Conclusions:
Based on this well-characterized COVID-19 ICU cohort, that comprised 12.7% of all severe ill COVID-19 patients, neurologic manifestations increase mortality and morbidity. Since no reliable evidence of direct viral affection of the nervous system by COVID-19 could be found, these neurologic manifestations may for a great part be indirect para- or postinfectious sequelae of the infection or severe critical illness. Neurologic ICU complications should be actively searched for and treated.
... This explains why there are fewer hospitalized stroke patients and a higher NIHSS score, which indicates a severe stroke. Patients having mild strokes during the COVID phase may be less likely to seek medical care [27,28]. Roushdy and colleagues in 2020 studied 93 Egyptian patients with acute ischemic stroke. ...
Background
Nearly 55 percent of patients are said to be affected by the neurological effects of COVID-19. COVID-19 was shown to be related with stroke in 0.9 to 5% of people. It's critical to assess the impact of COVID-19 on the outcomes of acute ischemic stroke. The goal of this study was to look at the outcomes and characteristics of patients who had an acute ischemic stroke due to covid-19 infection.
Results
The participants in this study were 399 people who had had a stroke. COVID-19 positivity was confirmed in 77 cases, while COVID-19 negativity was confirmed in 322. In the COVID-19 and control groups, the average age of the patients was 65.4 ± 10.2 and 65.3 ± 11.8, respectively. The Covid-19 and control groups had a mean stroke onset of 5.2 ± 2.1 and 5.7 ± 3.8 h, respectively ( P = 0.12). There was a high in-hospital mortality rate among patients with COVID-19 with a rate of 11.7% compared to 4.04% among the control group ( P = 0.02). At discharge, the number of patients with mRS > 2 was higher ( P = 0.001) among the COVID-19. There was a correlation between the mean levels of D-Dimer ( r = 0.668, P < 0.001), the severity of COVID-19 ( r = 0.802, P < 0.001), and mRS > 2.
Conclusion
Despite receiving equal acute care as non-COVID-19 patients, COVID-19 patients had more severe strokes and had worse outcomes. This includes a high chance of death while in the hospital as well as a significant level of disability. Neurologists should use timely and effective therapies, particularly for patients who are at a higher risk of having a stroke . This includes elderly patients, patients with severe COVID-19, patients with high levels of D-Dimer, and those with high NIHSS.
... 15) Initial reports from Wuhan, China, revealed a high risk of stroke among COVID-19-infected patients, with a frequency of 5%, especially those with severe infection. 16,17) Contrarily, consistent declines in the absolute volumes of IS admissions due to COVID-19 have been reported; however, the magnitude of the reduction varied according to the severity of the pandemic in the studied countries and the observation period. Studies involving a few months of observation in early 2020 observed reductions in visits or consultations among patients with acute IS by 30%-40%. ...
This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.
... A retrospective study performed in China and for 221 patients showed the development of IS in 11 people (5% of all patients in the sample), cerebral venous sinus thrombosis in one patient, and intracerebral hemorrhage in one more patient [43]. In another prospective examination of 288 patients, IS was diagnosed in 9 patients (2.5% of the total number of subjects) [44]. ...
Based on the available publications, the article systematizes information about some forms of lesions of the central nervous system (CNS), their pathogenesis, and clinical manifestations in COVID-19. Risk factors, developmental mechanisms, diagnostic approach, age characteristics of patients with neurological complications of COVID-19 are discussed. The specific mechanisms of the neuroinvasiveness and neurovirulence of the SARS-CoV-2 virus, regardless of the age of patients and the presence of risk factors, lead to systemic damage to the endothelium of small-caliber vessels, generalized thrombovasculitis, and an increased risk of ischemic and hemorrhagic strokes. At the same time, the most vulnerable category is elderly and senile patients with cardiovascular and metabolic disorders (arterial hypertension, obesity, diabetes mellitus), which sharply worsen treatment outcomes. The clinical experience accumulated during the COVID-19 pandemic indicates the development of the following most frequent post-covid neurological complications and consequences in mainly elderly and senile patients: cranial mononeuropathies, chemosensory dysfunction, encephalopathy, insomnia, stroke, acute meningoencephalitis, acute disseminated encephalomyelitis syndrome acute polyneuropathy Guillain-Barré, transverse myelitis. The benefits of vaccination against COVID-19 far outweigh the risks of possible post-vaccination neurological complications and consequences, especially in elderly and senile patients.
... Those with "severe" SARS-CoV-2 infections were shown to be more likely to have neurological problems [6,7]. In a study conducted by Li et al., out of 221 patients, 6% of them got serious neurological disease, including ischemic stroke, hemorrhage, and cerebral vein thrombosis, with a large proportion of them leading to death [8]. ...
Many studies conducted after the pandemic period revealed that, while COVID-19 primarily injured the lungs, it also affects other organs in the form of cardiovascular complications, metabolic derangements, renal damage, and so on. Although we know that inflammatory cascades, complement activation, and pro-inflammatory cytokines are all involved in vasculitic processes that cause organ damage, we do not know the exact mechanism of complications such as acute respiratory distress syndrome (ARDS), cardiovascular ischemia, deep vein thrombosis, pulmonary thromboembolism, and brain injuries (embolism) that are frequently observed in COVID 19. The currently available biomarkers do not predict the severity of the aforementioned complications. As a result, more specific biomarkers such as serum calcium binding protein (S100B), glial fibrillary acid protein (GFAP), myelin basic protein (MBP), neuron-specific enolase (NSE), hs-TNI, (highly sensitive cardiac troponin) – HBDH, (Hydroxybutyrate Dehydrogenase), CK-MB (creatine kinase myocardial band), ST2 (suppression of tumorigenicity 2) are in need for early detection & improved clinical outcome.
... Prior studies have found that elevated markers of inflammation and coagulation, particularly D-dimer, are associated with an increased risk for stroke in patients with COVID-19 infection. 19,36 Because of a high rate of missingness predisposing to selection bias, we restricted our analysis of D-dimer to an exploratory analysis, the results of which are hypothesis-generating. Third, as we aimed to build a stroke risk stratification score that could be implemented upon hospital presentation, we did not account for in-hospital events such as acute respiratory distress syndrome, mechanical ventilation, venous thromboembolism, or administered anti-viral and anti-thrombotic medications, which could have affected stroke risk among patients hospitalized with COVID-19. ...
Objectives
: To derive models that identify patients with COVID-19 at high risk for stroke.
Materials and Methods
: We used data from the AHA's Get With The Guidelines® COVID-19 Cardiovascular Disease Registry to generate models for predicting stroke risk among adults hospitalized with COVID-19 at 122 centers from March 2020-March 2021. To build our models, we used data on demographics, comorbidities, medications, and vital sign and laboratory values at admission. The outcome was a cerebrovascular event (stroke, TIA, or cerebral vein thrombosis). First, we used Cox regression with cross validation techniques to identify factors associated with the outcome in both univariable and multivariable analyses. Then, we assigned points for each variable based on corresponding coefficients to create a prediction score. Second, we used machine learning techniques to create risk estimators using all available covariates.
Results
: Among 21,420 patients hospitalized with COVID-19, 312 (1.5%) had a cerebrovascular event. Using traditional Cox regression, we created/validated a COVID-19 stroke risk score with a C-statistic of 0.66 (95% CI, 0.60-0.72). The CANDLE score assigns 1 point each for prior cerebrovascular disease, afebrile temperature, no prior pulmonary disease, history of hypertension, leukocytosis, and elevated systolic blood pressure. CANDLE stratified risk of an acute cerebrovascular event according to low- (0-1: 0.2% risk), medium- (2-3: 1.1% risk), and high-risk (4-6: 2.1-3.0% risk) groups. Machine learning estimators had similar discriminatory performance as CANDLE: C-statistics, 0.63-0.69.
Conclusions
: We developed a practical clinical score, with similar performance to machine learning estimators, to help stratify stroke risk among patients hospitalized with COVID-19.
... Unsettlingly, largevessel strokes in young and generally healthy people, which became infected with SARS-CoV-2, have been consistently reported [25,55]. Early retrospective studies, seemingly corroborated these findings, claiming that acute, new-onset, cerebrovascular disease was not uncommon in COVID-19 patients -out 219 consecutive COVID-19 patients, 10 (4.6%) developed acute ischemic stroke and 1 (0.5%) had intracerebral hemorrhage [58] -,and that SARS-CoV-2 infection carried an increased risk of ACS, especially via coronary stent thromboses [59]. Nevertheless, investigations involving a much larger sample size showed that the actual incidence of ATE (thrombotic/ embolic) is, in fact, much lower than initially reported in earlier studies [51,60]. ...
Although the infection with the severe acute respiratory syndrome (SARS-CoV-2) virus affects primarily the respiratory system, it became evident from the very beginning that the coronavirus disease 2019 (COVID-19) is frequently associated with a large spectrum of cardiovascular involvements such as myocarditis/pericarditis, acute coronary syndrome, arrhythmias, or thromboembolic events, explained by a multitude of pathophysiological mechanisms. Individuals already suffering of significant cardiovascular diseases were more likely to be infected with the virus, had a worse evolution during COVID-19, with further deterioration of their basal condition and increased morbidity and mortality, but significant cardiac dysfunctions were diagnosed even in individuals without a history of heart diseases or being at low risk to develop such a pathology. Cardiovascular complications may occur anytime during the course of COVID-19, persisting even during recovery and, potentially, explaining many of the persisting symptoms included now in terms as subacute or long-COVID-19. It is now well accepted that in COVID-19, the occurrence of cardiovascular impairment represents a significant negative prognostic factor, immensely rising the burden of cardiovascular pathologies.
... In another study found that the risk of ischemic stroke increased by 5% during COVID-19 infection (95% confidence interval: 2.8-8.7%). The incidence of hemorrhagic stroke during COVID-19 infection was found to be very low compared to ischemic strokes [17]. In our study, there was an increase in the number of patients presenting with both ischemic and hemorrhagic stroke during the pandemic time. ...
The most common neurological disease in the world and one of the leading reasons for mortality is stroke. In addition to its effect on many systems of the body, COVID-19 infection also affects the central nervous system and causes neurological involvement. In our study, we examined the effects of the COVID-19 pandemic on stroke by comparing the pre-pandemic and pandemic times. Patients who presented to the emergency department with a stroke during the same time in two different years were included in the study. Patients with clinical conditions mimicking stroke in the differential diagnosis, those with a positive polymerase chain reaction test for COVID-19, and those with COVID-19 pneumonia were excluded from the sample. Patients diagnosed with stroke were examined using clinical, laboratory, and radiological imaging methods. Length of stay in hospital (service or intensive care unit) and mortality rates were recorded. There was no significant difference between the pre-pandemic and pandemic times in relation to the incidence of ischemic and hemorrhagic stroke, sex, and age. Although the number of patients presenting with an ischemic stroke increased during the pandemic time, the rate of acute ischemic stroke patients decreased. In addition, there was a decrease in the rates of patients who underwent intravenous thrombolytic and mechanical thrombectomy. Stroke cases increased during the pandemic time, but the rate of admission for acute ischemic stroke decreased. Because of this reason patients delaying their hospital visits because of pandemics lost their chance of acute treatment.
... In another study reported from France, neurological manifestations were reported to be present in 84% of patients with Covid-19 admitted to the ICU (5) . Acute cerebrovascular diseases particularly acute ischemic stroke were reported up to 6% of hospitalized patients with severe inflammatory state (6) . We also reported various neuroimaging complications seen in our patients including stroke, splenial corpus callosum lesion and spondylodiscitis complicated with psoas abscess in our previous studies (7,8) . ...
Encephalopathic symptoms including headache and altered mental status in hospitalized patients due to Covid-19 infection have been reported frequently in the recent literature.Moreover, neuroimaging correlation of some of these patients have been deonstrated with various forms of encephalitis. We aimed to describe the neuroimaging manifestations of an acute encephalitis with widespread involvement of deep white matter and deep gray matter areas that resolve following steroid treatment in a young male patient. We hope our case will add in the understanding of the range of neurological involvemnets related with Covid-19. More data about neuroimaging and neuropathological examinations are need to determine the neurotropism and particular types of involvements in the central nervous system.
... Some non-specific neurological symptoms are also observed such as confusion and headache. Some COVID-19 patients exhibit more specific neurological conditions like seizures or cerebrovascular problems [39]. Possible pathogenesis of the COVID-19 is shown by Wu et al. [40]. ...
COVID-19 resulted in a pandemic causing respiratory infection due to the SARS-CoV-2 virus. It started from the Wuhan city of China in mid-December 2019 and then spread all over the world in a very short time. COVID19 is mainly responsible for acute respiratory syndrome however, there are reports of involvement of some neurological symptoms and conditions wise; headache, dizziness, fatigue, insomnia, confusion and myalgia, encephalitis etc. The severe neurological effects consist of acute ischemic stroke, cerebral hemorrhage, cerebral venous sinus thrombosis, subarachnoid hemorrhage, acute necrotizing hemorrhagic encephalopathy, meningitis/encephalitis, and acute Guillain-Barre Syndrome. Neurological conditions could be due to the entrance of the virus into the brain via nasal passage through the olfactory bulb or the initiation of a storm of cytokines that cross the blood-brain barrier (BBB). It can also have a long-term effect in the form of demyelination of neurons which can lead to neurodegenerative diseases. This review deals with the general mechanisms which might be involved in the entrance of COVID-19 into the brain and its possible effects.
... Without knowledge of timing of stroke relative to these advanced treatments, we cannot determine the direction of the association. The majority of studies (22)(23)(24)(25), but not all (26,27) report stroke occurrence predominantly in critically ill patients. In our study, almost half of patients with stroke associated with SARS-CoV-2 infection were diagnosed upon admission, arguing against the idea that stroke occurs solely later in the course of prolonged critical illness. ...
To describe the prevalence, associated risk factors, and outcomes of serious neurologic manifestations (encephalopathy, stroke, seizure, and meningitis/encephalitis) among patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Design:
Prospective observational study.
Setting:
One hundred seventy-nine hospitals in 24 countries within the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 Registry.
Patients:
Hospitalized adults with laboratory-confirmed SARS-CoV-2 infection.
Interventions:
None.
Results:
Of 16,225 patients enrolled in the registry with hospital discharge status available, 2,092 (12.9%) developed serious neurologic manifestations including 1,656 (10.2%) with encephalopathy at admission, 331 (2.0%) with stroke, 243 (1.5%) with seizure, and 73 (0.5%) with meningitis/encephalitis at admission or during hospitalization. Patients with serious neurologic manifestations of COVID-19 were older with median (interquartile range) age 72 years (61.0-81.0 yr) versus 61 years (48.0-72.0 yr) and had higher prevalence of chronic medical conditions, including vascular risk factors. Adjusting for age, sex, and time since the onset of the pandemic, serious neurologic manifestations were associated with more severe disease (odds ratio [OR], 1.49; p < 0.001) as defined by the World Health Organization ordinal disease severity scale for COVID-19 infection. Patients with neurologic manifestations were more likely to be admitted to the ICU (OR, 1.45; p < 0.001) and require critical care interventions (extracorporeal membrane oxygenation: OR, 1.78; p = 0.009 and renal replacement therapy: OR, 1.99; p < 0.001). Hospital, ICU, and 28-day mortality for patients with neurologic manifestations was higher (OR, 1.51, 1.37, and 1.58; p < 0.001), and patients had fewer ICU-free, hospital-free, and ventilator-free days (estimated difference in days, -0.84, -1.34, and -0.84; p < 0.001).
Conclusions:
Encephalopathy at admission is common in hospitalized patients with SARS-CoV-2 infection and is associated with worse outcomes. While serious neurologic manifestations including stroke, seizure, and meningitis/encephalitis were less common, all were associated with increased ICU support utilization, more severe disease, and worse outcomes.
... These neurologic symptoms had occurred 10 days after the infection on average. These patients' mean age was higher (75.7 ± 10.8 years versus 52.1 ± 15.3 years), and they had more cardiovascular risk factors [14]. However, in this current case, COVID-19 infection first manifested with neurological symptoms, and subsequently, upper respiratory symptoms appeared. ...
Background
Although coronavirus disease 2019 affects mainly the respiratory system, as time passes and our understanding of the disease improves, many nonrespiratory clinical manifestations such as thromboembolic events have been shown to occur with or without respiratory tract involvement.
Case presentation
We present the case of a 21-year-old gravid 3, live 1, abortion 1 Iranian woman pregnant with twins in her early first trimester. Her initial chief complaint was headache that gradually increased in intensity. Eventually, cerebral vein thrombosis was confirmed. Although the patient first manifested with neurological involvement, she developed upper respiratory symptoms soon after, and then nasopharyngeal polymerase chain reaction test returned positive.
Conclusion
Any neurological complaints in pregnant women during the current coronavirus disease 2019 pandemic should raise suspicion for the presence of significant cerebral thrombotic or ischemic events, even if the patient has no complaint of respiratory tract involvement and/or when an initial nasopharyngeal polymerase chain reaction test is negative.
... In addition, they mentioned CVD could be a negative prognostic factor in COVID-19 patients. 10 It should be considered that the authors studied only symptomatic COVID-19 patients, which leads to overlooking other non-symptomatic patients who might develop stroke. ...
Objective
The objective of this study was to evaluate how COVID-19 affects patients with acute ischemic or hemorrhagic stroke outcome.
Materials and Methods
This retrospective study was performed on adult patients (> 18 years old) with stroke (ischemic or hemorrhagic) who were admitted to hospital with or without COVID-19. The primary outcome was stroke-related disability, which was measured by mRS at baseline and discharge. Hospital duration, intensive care unit (ICU) admission, and mortality were considered the secondary outcomes.
Results
From February 2019 until August 2020, we recruited and analyzed 151 patients, 42 of whom had COVID-19 based on RT-PCR tests or lung CT scan findings. COVID-19 positive patients had higher baseline and final mRS scores than the control group (4.46± 0.67 vs 4.79± 0.61, P: 0.001, 3.83±1.22 vs 4.46± 0.67, P: 0.001). Moreover, stroke patients with COVID-19 experienced a more severe disease and required a higher rate of ICU admission (17 vs 0, P:0.001) and longer hospitalization compared to those without COVID-19 (8.50±7.86 vs 7.5±11.20, P: 0.021). Also, mortality was higher in the COVID-19 group (19 vs 13, P:0.001). There was not any significant differences between the two groups in terms of the involvement of cerebral arteries and type of stroke. Male sex, COVID-19, and ICU admission were the main independent risk factors for death.
Conclusion
The results of the study showed stroke patients (ischemic or hemorrhagic) with COVID-19 can have more disabilities and incur more hospital complications and mortality than non-COVID-19 patients.
COVID 19 a plague that has been spread worldwide in a brief time period. It is a sickness caused by contamination with the newly localized coronavirus "SARScoV2". Health specialists appreciate and tried for offerings that are near most people, irrespective of the chance of contamination. Consequently, in such situations, it ought to be essential to evaluate the statistics and views of medical specialists and numerous human beings particularly this pandemic and speak the effect of this catastrophe on psychosocial balance. The usual educational intervention sand schooling packages for COVID 19 pollutants manipulation and practices in all healthcare specialists are lacking, place of work fitness and safety are paramount to reducing the chance of transmission to students, healthcare experts and healthcare experts.
Objectives:
The present review describes stroke pathophysiology in brief and discusses the spectrum of available treatments with different promising interventions that are in clinical settings or are in clinical trials.
Methods:
Relevant articles were searched using Google Scholar, Cochrane Library, and PubMed. Keywords for the search included ischemic stroke, mechanisms, stroke interventions, clinical trials, and stem cell therapy.
Results and conclusion:
Stroke accounts to a high burden of mortality and morbidity around the globe. Time is an important factor in treating stroke. Treatment options are limited; however, agents with considerable efficacy and tolerability are being continuously explored. With the advances in stroke interventions, new therapies are being formulated with a hope that these may aid the ongoing protective and reparative processes. Such therapies may have an extended therapeutic time window in hours, days, weeks, or longer and may have the advantage to be accessible by a majority of the patients.
Since the intial outbreak of the coronavirus-2019 (COVID-19) in December 2019, a variety of neurologic manifestations have been linked to this virus, including stroke. Comprehensive review of worldwide studies using various methodologies indicated a correlation of increased stroke risk in patients with COVID-19. The literature reivew also revealed increased morbidity and mortality among patients with COVID-19 and stroke as compared to those with only stroke. This pandemic, with its related healthcare staffing shortages, revealed the requisite to utilize innovative technologies such as Tele-Neurology, as well as public health campaigns focusing on stroke recognition and early treatment.
Objectives
to assess whether COVID-19 could be a concurrent factor in the genesis and/or worsening of stroke and to provide data on COVID-19 –associated stroke patients during the first pandemic wave and comparative data on COVID-19 negative stroke patients in the same period.
Materials and Methods
this is a retrospective, observational, case-control, single centre study, carried out in a General Hospital in northern Italy. Sixty-three consecutive stroke patients were included, COVID-19-associated stroke was classified as cases and non COVID-19-associated stroke as controls.
Results
a total of 19/63 (28.8%) had a COVID-19-associated stroke, 11 /63 (17.5%) were haemorrhagic and 52/63 (82.5%) ischaemic. COVID-19-associated strokes were more severe (p-value 0.019) and had a higher risk of severe disability and/or death (OR 3.79, CI 95%: 1.21-11.93, p-value 0.19). The COVID-19-associated stroke patients with onset during hospitalization for COVID-19 had a more severe stroke than patients with COVID-19 onset during hospitalization for stroke (p-value 0.019).
Conclusion
although no relationship was observed between the stroke aetiology and COVID-19, intriguingly, COVID-associated stroke turned out to be more severe and disabling. Hopefully, further studies will provide more data and help in the management of this emerging population.
A large proportion of patients with coronavirus disease 19 (COVID‐19) suffer from excessive coagulation activation and coagulopathy which predisposes them to a wide spectrum of thrombotic events including in situ pulmonary thrombosis, deep‐vein thrombosis, and associated pulmonary embolism, as well as arterial thrombotic events. Cerebral venous sinus thrombosis (CVST) have also been reported but in a very small number of cases. This report aims to increase awareness about CVST as a potential neurological thromboembolic complication in patients with coronavirus disease. We report three COVID‐19 patients presenting with CVTS. We also review all previously described cases and present an overview of their demographic, clinical, and diagnostic data. We describe three patients with concomitant coronavirus disease and CVST among 1000 hospitalized COVID‐19 patients (2 males, 1female, and mean age of 37 years). One patient was previously healthy, while the two others had a history of chronic anemia and ulcerative colitis, respectively. CVST symptoms including seizure in two patients and headache in one patient occurred day to weeks after the onset of COVID‐19 symptoms. Three months of anticoagulant therapy was given for all three patients with favorable outcomes. No neurological sequelae and no recurrence occurred within 6 months after hospital discharge. Our search identified 33 cases of COVID‐19 complicated by CVST. The mean age was 45.3 years, there was a slight male predominance (60%), and more than half of cases were diagnosed in previously healthy individuals. All cases of CVT were clinically symptomatic and were observed in patients with a different spectrum of coronavirus disease severity. Headache was the most common complaint, reported by just less than half of patients. There was a high mortality rate (30.3%). CVT is a very rare, but potentially life‐threatening complication in patients with COVID‐19. It's mainly reported in relatively young individuals with no or little comorbid disease and can occur even in patients who do not display severe respiratory symptoms. Atypical clinical presentations may pose a challenge to the early diagnosis and treatment. High suspicion is necessary as early diagnosis and prompt treatment with anticoagulation in all patients with COVID‐19 and CVT could contain the mortality rate and improve neurological outcomes in these patients.
Background
Cerebrovascular diseases (CVDs), including varying strokes, can recur in patients upon coronavirus disease 2019 (COVID-19) diagnosis, but risk factor stratification based on stroke subtypes and outcomes is not well studied in large studies using propensity-score matching. We identified risk factors and stroke recurrence based on varying subtypes in patients with a prior CVD and COVID-19.
Methods
We analyzed data from 45 health care organizations and created cohorts based on ICDs for varying stroke subtypes utilizing the TriNetX Analytics Network. We measured the odds ratios and risk differences of hospitalization, ICU/critical care services, intubation, mortality, and stroke recurrence in patients with COVID-19 compared to propensity-score matched cohorts without COVID-19 within 90-days.
Results
22,497 patients with a prior history of CVD within 10 years and COVID-19 diagnosis were identified. All cohorts with a previous CVD diagnosis had an increased risk of hospitalization, ICU, and mortality. Additionally, the data demonstrated that a history of ischemic stroke increased the risk for hemorrhagic stroke and transient ischemic attack (TIA) (OR:1.59, 1.75, p-value: 0.044*, 0.043*), but a history of hemorrhagic stroke was associated with a higher risk for hemorrhagic strokes only (ORs 3.2, 1.7, 1.7 and p-value: 0.001*, 0.028*, 0.001*). History of TIA was not associated with increased risk for subsequent strokes upon COVID-19 infection (all p-values: ≥0.05).
Conclusions
COVID-19 was associated with an increased risk for hemorrhagic strokes and TIA among all ischemic stroke patients, an increased risk for hemorrhagic stroke in hemorrhagic stroke patients, and no associated increased risk for any subsequent strokes in TIA patients.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China, in late 2019 and caused coronavirus disease 2019 (COVID-19), which is still a global pandemic. In most infected people, SARS-CoV-2 can only cause moderate symptoms, while in other patients, it leads to severe illness and eventually death. Although the main clinical manifestation of COVID-19 is often seen in the lungs, this disease affects almost all body organs. The excessive and prolonged release of inflammatory cytokines that may occur in COVID-19 patients, known as cytokine storms, stimulates undesired immune responses and can cause various tissues damage. In the current review article, we focus on the potential advantages of the intrinsic cholinergic anti-inflammatory pathway (CAP) as the efferent arm of inflammatory reflex in COVID-19 management. Considering this endogenous protective mechanism against chronic inflammation, we focused on the effects of SARS-CoV-2 in the destruction of this anti-inflammatory system. Several studies indicated the interaction of SARS-CoV-2 with the alpha7 subtype of the nicotinic acetylcholine receptor as the effector molecule of the inflammatory reflex. On the other hand, neurological manifestations have increasingly been identified as significant extrapulmonary manifestations of COVID-19. The rational connection between these findings and COVID-19 pathogenesis may be an important issue in both our understanding and dealing with this disease. COVID-19 is deeply rooted in our daily life and requires an urgent need for the establishment of effective therapeutic options, and all the possible treatments must be considered for the control of such inflammatory conditions.
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