cord-006182-kck5e1ry	2019	The primary objective of COGiTATE (CppOpt GuIded Therapy Assessment of Target Effectiveness) is to demonstrate feasibility of individualising CPP at CPPopt in TBI patients, expressed as the percentage of monitoring time for which CPP is within 5 mmHg of regularly updated CPPopt targets during the first 5 days of Intensive Care Unit (ICU) admission. Neurocritical care has become increasingly subspecialized.Yet, due to limited availability of dedicated Neurocritical Care units (NCCUs), often patients may need to be admitted to ICUs other than NCCUs. This survey based study was conducted to explore self-reported knowledge in recognizing and managing some common neurological emergencies such as stroke, status epilepticus, raised intracranial pressure etc among critical care nurses at a Comprehensive Stroke Center. Coagulation factor Xa (recombinant), inactivated-Xa inhibitor associated life--factor prothrombin complex concentrate (PCC) was utilized offRetrospective, single center, cohort study including adult intracranial hemorrhage patients who received discharge between efficacy (defined by International Society on Thrombosis and Haemostasis criteria), thrombotic events, ICU and hospital length of stay, and mortality.
cord-006870-f5w6fw6q	2017	Subjective perceptions of recovery were assessed via responses to the forced-choice dichotomized question, "Do you feel that you have made a complete recovery from the arrest?"Objective outcome measures of recovery included: Repeatable Battery for Neuropsychological Status (RBANS), Modified Lawton Physical Self-Maintenance Scale (L-ADL), Barthel Index (BI), Cerebral Performance Category Scale (CPC), Center for Epidemiological Studies-Depression scale (CES-D), and Post traumatic stress disorder-checklist (PTSD-C). Utilizing data from the Citicoline Brain Injury Treatment (COBRIT) trial, a prospective multicenter study, we identified 224 patients who met the inclusion criteria; 1) placement of an ICP monitoring device, 2) Glasgow coma score (GCS) less than 9, 3) EVD placement prior to arrival or within 6 hours of arrival at the study institution. The objective of this study was to examine the incidence rates of pre-specified medical and neurological ICU complications, and their impact on post-traumatic in-hospital mortality and 12month functional outcomes.
cord-010977-fwz7chzf	2020	In this review, we describe some of the approaches being taken to apply translational genomics to the study of diseases commonly encountered in the neurocritical care setting, including hemorrhagic and ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and status epilepticus, utilizing both forward and reverse genomic translational techniques. Termed "reverse translation," this approach starts with humans as the model system, utilizing genomic associations to derive new information about biological mechanisms that can be in turn studied further in vitro and in animal models for target refinement (Fig. 1) . These results highlight the value of reverse genomic translation in first identifying human-relevant genetic risk factors for disease, and using model systems to understand the pathways impacted by their introduction to select rationally-informed modalities for potential treatment. These observations provide vital information about cellular mechanisms impacted by human disease-associated genetic risk factors without requiring the expense and time investment of creating, validating, and studying animal models.
cord-011483-zc6ve6le	2020	Neurostimulant administration data were extracted from the electronic medication administration record, including medication (amantadine, modafinil, or both), starting dose, time from stroke to initiation, and whether the neurostimulant was continued at hospital discharge. Amantadine and modafinil are administered to patients following acute stroke in our intensive care unit (ICU) on an ad hoc basis, but data supporting this practice are largely limited to delayed treatment in rehabilitation or outpatient facilities with very few reports during the acute care hospitalization [17] [18] [19] . Two hundred five patients received amantadine and/ or modafinil during the 3.7 year study period and 118 patients were initially excluded: neurostimulant administered for an indication other than acute stroke (TBI [n = 50], cardiac arrest [n = 15], brain tumor [n = 6], encephalitis [n = 5], or encephalopathy [n = 4]); neurostimulant prescribed prior to hospital admission (n = 27) or administered for < 72 h (n = 8); or history of seizures (n = 3).
cord-016906-ynfb10pq	2016	One study demonstrated that injection of CXCR4 inhibitor AMD3100 into ischemic mice during acute phase significantly suppressed inflammatory response and reduced blood-brain barrier disruption via inhibiting leukocyte migration and infiltration [39] ; however, another study showed that overexpression of SDF-1 in mice brain during post-acute phase promoted neurovascular recovery, neurogenesis, and angiogenesis through enhancing migration of neural progenitor cells and endothelial cells, while AMD3100 reversed protective effects of SDF-1 [66] . Transduced ASC-shHGF secreted >80 % less HGF, which led to a reduced ability to promote survival, proliferation, and migration of mature and progenitor endothelial cells in vitro IGF-1 [156] MSC Permanent coronary artery occlusion IGF-1 transgene expression induced massive stem cell mobilization via SDF-1α signaling and culminated in extensive angiomyogenesis in the infarcted heart GDNF [163] NPC Stroke More NSPC-GDNF cells migrated toward the ischemic core, reduced infarct volume, and improved behavioral recovery SCF [193] NSPCs Normal mice Recombinant SCF induces potent NSPC migration in vitro and in vivo through the activation of c-kit on NSPCs MicroRNA 9 [153] hESC-derived neural progenitors Stroke hNPCs without miR-9 activity also showed enhanced migration Y.
cord-027259-f4sgobcz	2020	On the basis of the analysis of 12 modern prognostic models from 10 countries we can identify some of the most stable (main) predictors for the causes of intra-hospital mortality: age [16, [20] [21] [22] [23] [24] ; type of stroke [25] ; lesion location [25] ; level of consciousness [11, 20, 23, 25, 26] upon admission; NIHSS stroke severity [10, 21, 22, 24] ; comorbidity [22, 27] , Charlson comorbidity index [23] , Atrial fibrillation [11, 22] , case history Transitor ischemic attack (TIA) [31]; hospital complications (high intracranial pressure) [16] , pneumonia, seizures, anxiety/depression, infections, limb pains and constipation [22, 27] . Early mortality in each subgroup was associated with a number of demographic, clinical, and instrumental-laboratory characteristics based on the interpretation of the results of calculating the significance of predictors of binary classification models by machine learning methods from the Scikit-Learn library 2 .
cord-032820-l0vkq0j3	2020	BACKGROUND: While COVID-19 pandemic affected more than 26 million people worldwide, still, the definite link between COVID-19 and incidence of stroke remains to be re-evaluated. The COVID-19 pandemic has, in different ways, negative impacts on care of stroke patients worldwide, and still, many challenges are faced by neurologists to improve care of stroke patients during such crisis. Another explanation may come from the observation that air pollution is associated with an increased risk of cardiovascular disease; we had seen a strikingly reduced air pollution during the pandemic secondary to lockdown; this phenomenon could have a protective effect against stroke [4] . From our experience, it was observed that the presence of cerebrovascular disease (CVD) in patients with SARS-CoV-1 or MERS-CoV was associated with worse outcomes. Cerebrovascular disease is associated with an increased disease severity in patients with coronavirus disease 2019 (COVID-19): a pooled analysis of published literature
cord-034257-kl2ccmz5	2020	title: PRECIOUS: PREvention of Complications to Improve OUtcome in elderly patients with acute Stroke—statistical analysis plan of a randomised, open, phase III, clinical trial with blinded outcome assessment AIMS AND DESIGN: PREvention of Complications to Improve OUtcome in elderly patients with acute Stroke (PRECIOUS) is an international, multi-centre, 3 × 2 factorial, randomised, controlled, open-label clinical trial with blinded outcome assessment, which will assess whether prevention of aspiration, infections, or fever with metoclopramide, ceftriaxone, paracetamol, respectively, or any combination of these in the first 4 days after stroke onset improves functional outcome at 90 days in elderly patients with acute stroke. The primary objective is to assess whether prevention of aspiration, infections, or fever with metoclopramide, ceftriaxone, paracetamol, or any combination of these in the first 4 days after stroke onset improves functional outcome at 90 days in older patients with acute stroke.
cord-103915-rzy7mejb	2018	We have previously shown that gene therapy delivery of human NT3 into the affected triceps brachii forelimb muscle improves sensorimotor recovery after ischemic stroke in adult and elderly rats. We also recently showed that injection of an adeno-associated viral vector (AAV) encoding full-length human NT3 (preproNT3, 30kDa) into forelimb muscles 24 hours after stroke in adult or elderly rats improved sensorimotor recovery 19 . We examined anatomical neuroplasticity in the C7 cervical spinal cord because we knew from experiments using adult and elderly rats that the less-affected corticospinal tract sprouts at this level (as well as other levels) after injection of AAV-NT3 into muscles including triceps brachii 19 . fMRI performed one week after stroke confirmed that somatosensory cortex was not active when the affected paw was stimulated in either vehicle or NT3 treated rats (p>0.05, Supplementary Fig. 6b ). Treatment of disabled arm muscles with NT3 protein, initiated 24 hours after stroke, caused changes in multiple locomotor circuits, and promoted a progressive recovery of sensory and motor function in rats.
cord-133894-wsnyq01s	2020	Stroke projection using a 2D interface is typically WYSIWYG: 2D points along a user stroke (a, inset) are ray-cast through the given view to create corresponding 3D curve points on the surface of 3D scene objects (a). e user-intended projection of a mid-air stroke ( § 3) as a result is complex, in uenced by the ever-changing 3D relationship between the view, drawing controller and virtual object. Our most promising and novel approach anchored-smooth-closest-point (also called mimicry), captures the natural tendency of a user stroke to mimic the shape of the desired projected curve. Anchored projection captures our observation that the mid-air user stroke tends to mimic the shape of their intended curve on surface. While users to do not adhere consciously to any precise geometric formulation of mimicry, we observe that users o en draw the intended projected curve as a corresponding stroke on an imagined o set or translated surface (Figure 7) .
cord-252687-7084pfqm	2020	Many clinical studies have shown an association between SARS-CoV-2 infection and hypercoagulability diagnosed on the basis of abnormal coagulation parameters, including activated partial thromboplastin time, prothrombin time, fibrinogen, D-dimer and C-reactive protein level. In this review, the potential mechanism and the effect of the SARS-CoV-2 viral infection on the development of ischemic stroke in COVID-19 patients were carefully studied. study, in which most non-survivor COVID-19 patients'' (71.4%) blood tests showed prolonged prothrombin time and an increased D-dimer levels, which indicated the state after activation of the plasma coagulation system [14] . The accumulation of immune cells in the vascular wall in response to the viral infection, especially among patients with ischemic risk factors, induces endothelial dysfunction, migration and proliferation of cells, activation of coagulation cascade and production of fibrous plaques.
cord-254423-jz6hoxk1	2020	During the peak period of the outbreak in February and March 2020, the implementation of national policies to avoid social gatherings and travel to high-risk areas [2] resulted in hospitals reducing outpatient clinics and many services were restricted to urgent cases. China is now emerging from this difficult period, but the shadow of COVID-19 continues, as we have encountered during initiation of the INTEnsive ambulance-delivered blood pressure Reduction in hyper-ACute stroke Trial (INTERACT4) (ClinicalTrials.gov NCT03790800, and Chinese Trial Registry ChiCTR-1900020534). As the effectiveness of reperfusion therapy in highly time-dependent, public health strategies encourage patients to urgently call an ambulance, so that they can present rapidly to hospital after the onset of symptoms suggestive of acute stroke, most popularly defined by the Face symmetry, Arm weakness, Speech slurring, and Time to call (FAST) tool. The main reason that patients were Song/Ouyang/Sun/Chen/Anderson Cerebrovasc Dis 2 DOI: 10.1159/000511394 excluded according to the ambulance screening logs is "delayed time from symptom onset" (>2 h [n = 39]).
cord-255604-hnbzidf3	2020	1 This pandemic has presented a major challenge to the care of patients with other medical conditions such as stroke, which affects 1 in 4 people over the age of 25 in their lifetime and kills about 5.5 million each year. 4 The latest survey data collected from the Chinese Stroke Center Alliance showed that among 328 hospitals during the period of pandemic, the admission rate of patients who had a stroke decreased by as much as 60%-80%. In addition, the ability of a hospital to care for patients who had a stroke may diminish due to the need to minimise exposure and reallocate work force and resources. Fourth, healthcare providers, including emergency medical physicians, are being infected at a higher percentage in certain countries, which may decrease the work force providing stroke care. 16 Based on these statements and a need to call for uninterrupted stroke care during this pandemic, this work group has composed the following recommendations:
cord-257074-baiqcoao	2020	The recent coronavirus disease (COVID‐19) pandemic intensely impacted the health systems worldwide, which had to deal with the challenge of contemporarily answering to the needs of COVID‐19 patients and managing other life threatening disorders. Several European countries such as Italy, France and Spain, particularly hit by the pandemic, had to deeply reorganize healthcare and to redistribute personnel, resources and beds to deal with the demands of the uncontrolled spreading of the COVID‐19 infection. reorganize healthcare and to redistribute personnel, resources and beds to deal with the demands of the uncontrolled spreading of the COVID-19 infection (1) . All rights reserved These two studies, although limited by a short observation time, are among the first to report data on stroke care quality changes in Europe at the time of the COVID-19 pandemic. Impact of the Covid-19 outbreak on acute stroke pathways -Insights from the Alsace region in France
cord-257433-qgkwylmk	2020	We collected the data on the patients that were referred to our hospital from March 9 to April 19 2020 either for ischemic or hemorrhagic stroke or for intracerebral cerebral hemorrhage (ICH), i.e., a timeframe of 42 days following the promulgation of the decree of the Lombardy Governor for the institution of the hub-and-spoke system. For each patient we acknowledged how he/she had reached the hospital (without or with the regional emergency transportation system AREU), the individual risk factors, the kind of stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification (4), the location of the stroke according to Oxfordshire Classification (OCSP) (5), the therapeutic procedures (IVT, EVT, CEA), and a justification in case no procedure was undertaken, the NIH Stroke Scale (NIHSS) score before and after the procedure.
cord-259845-kjbhmsqr	2020	In the following period, only few small case series of COVID-19 stroke patients have been reported [3] [4] [5] [6] [7] [8] . Despite the lack of current scientific literature on the topic, which is limited to anecdotal reports, numerous hypotheses have been put forward as to the role of the thrombophilic state induced by 2019-nCoV and the likely increased risk of stroke in infected patients [9] [10] [11] . Indeed, the prevalence of COVID-19 is so high in pandemic hotspots that an incidental association between infection and neurological manifestations cannot be excluded. During a pandemic, when science and medicine are asked to provide answers, neurologists should strive to keep high scientific research standards and place trust in their clinical methods, starting with an accurate patient interview and then moving through standard neurological examination. Neurologic features in severe SARS-CoV-2 infection Acute ischemic stroke complicating common carotid artery thrombosis during a severe COVID-19 infection
cord-267402-kca05rvz	2020	What follows herein is a detailed summary of the current literature surrounding COVID-19, encompassing the immune and inflammatory responses to infection, thrombotic manifestations and vascular consequences of infection with a focus on possible mechanisms by which these elements may contribute to acute stroke events. 89 This is not the case in COVID-19 (and the previous SARS outbreak) and a recent retrospective cohort study has suggested an incidence of stroke 7-8 times higher in patients hospitalized with COVID-19 infection compared with those hospitalized by influenza, 90 supporting the possibility of a SARS-CoV-2-driven hyper-coagulant state. [91] [92] [93] Obesity, in particular, is emerging as a prominent risk factor in the development of severe COVID-19 disease and is generally associated with increased incidence and increased severity of respiratory viral infection. Notably, the cytokine IL-33 is persistently elevated in obese individuals and is capable of stimulating endothelial cells to release pro-coagulant tissue factor 97 which may expose them to more severe COVID-19 disease and/or stroke.
cord-270475-mkpn9tz6	2020	Although COVID-19 pandemic has produced an enormous collateral damage over stroke systems of care leading to a drop of mild strokes admissions and late arrival of severe strokes, only incidental cases of large vessel occlusion (LVO) in young adults infected by SARS-CoV-2 have been reported without a clear causative relationship (4) . The presence of SARS-CoV-2 infection has been associated with worse functional outcome and higher mortality among patients with acute stroke (11) ; in parallel, history of stroke has also been associated with more severe clinical symptoms and poorer outcomes in patients with COVID-19 (12) . From March 2 nd to April 30 th , 2050 patients were admitted to our center with RT-PCR confirmed SARS-CoV-2 infection; of them 21 (1.02%) presented an acute ischemic stroke 21 and 4 (0.2%) suffered an ICH. Our study shows that the frequency of acute stroke in patients with COVID-19 requiring hospital admission is low (1%) and in most cases a usual cause of stroke was identified.
cord-271168-a9sf8f4p	2020	To quantify the impact of the pandemic, the number of stroke code activations, ambulance transfers, consultations through telestroke, stroke unit admissions, and reperfusion therapy times and rates are described in temporal relationship with the rising number of COVID-19 cases in the region. Therefore, to better understand how the acute stroke care situation in the era of the COVID pandemic crisis might be affected, we evaluated the number of stroke cases attending and treated at a south European region before and during the outbreak. Unfortunately, we observed a sharp decrease in the number of stroke code activations and ambulance transfers, a reduction in consultations through telestroke, the number of patients admitted to our stroke units, and treated with IV tPA or receiving thrombectomy, which had a clear temporal relationship with the rising number of COVID-19 cases that crowded our hospitals.
cord-274810-vfr1g9kp	2020	However, actual situation might be even more dire, since such statistics likely do not fully display the entire impact of COVID-19, especially with regard to its influence on patients with a history of stroke who need to take cardiovascular drugs regularly to prevent recurrent vascular events. Clinical trial evidence shows that stroke patients with atrial fibrillation assigned to apixaban, a novel oral anticoagulant, compared with aspirin, had a substantially lower risk of recurrent stroke or systemic embolism (2.4% vs 9.6% per year, hazard ratio 0.29, 95% confidence interval [CI] 0.15 to 0.60). On the other hand, a large cohort study showed that discontinuation of aspirin was associated with a 40% increase in the risk of ischemic stroke compared with continuation of therapy in people taking aspirin for the secondary prevention of cardiovascular or cerebrovascular events. An Italian cohort study showed that in first-ever ischemic stroke patients who were 18 to 45 years, discontinuation of antihypertensive drugs was independent predictors of recurrent cardiovascular events.
cord-277011-0khsxhwv	2020	In this issue of the European Journal of Neurology, colleagues from Italy, France and Germany provide an overview of policy responses and changes in the provision of stroke care in their countries in the first few months of the COVID-19 outbreak 1 . Several common experiences stand out from the report, albeit at somewhat different extent, such as a reduction in the numbers of stroke admissions, increases in the numbers of intensive care unit beds, reduction or suspension of elective interventions and outpatient visits, and institution of screening procedures and other protection measures to prevent the spread of COVID-19 among patients and healthcare providers. In their report the authors offer an international perspective on the modifications in stroke care during the pandemic and provide insight into differences between countries in policy measures and in challenges faced by stroke care providers. Stroke Care During The Covid-19 Pandemic: Experience From Three Large European Countries
cord-280733-d44se0v3	2020	As part of an effort to reduce the consequences of this outbreak on health service delivery to stroke patients, the European Stroke Organisation has undertaken a survey aimed at collecting information on the provision of stroke care during the pandemic. Among European respondents, 289 (77%) reported that not all stroke patients were receiving the usual care in their centres and 266 (71%) estimated that functional outcomes and recurrence rates of stroke patients would be negatively affected by the organisational changes caused by the pandemic. As part of the ongoing effort to reduce the consequences of COVID-19 on health service delivery to stroke patients, the European Stroke Organisation (ESO) has undertaken a survey aimed at collecting information on the current provision of stroke care. Because Italy and Spain were the most affected countries in Europe at the time of the survey, sensitivity analyses excluding respondents from other countries were performed for items related with delivery of stroke care and availability of personal protective equipment.
cord-282956-f7if9e5q	2020	BACKGROUND AND PURPOSE: With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. METHODS: We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 15, 2020, and April 19, 2020, within a major health system in New York, the current global epicenter of the pandemic. In this multi-ethnic study, we report key demographic and clinical characteristics of patients who develop ischemic stroke associated with acute severe acute respiratory syndrome CoV-2 coronavirus infection. The observed rate of imaging-confirmed acute ischemic stroke in hospitalized patients with COVID-19 of 0.9% was lower compared with prior reports from Chinese COVID-19 studies.
cord-287742-y1j9x5ne	2020	Therefore, we performed a systematic review and meta-analysis of currently available epidemiological, clinical, and laboratory data related to both stroke and COVID-19 infection. We, therefore, performed a systematic review and metaanalysis involving the epidemiological, clinical presentation, imaging characteristics, and laboratory finding related to both stroke and COVID-19 infection. The following data were extracted from every study: the last name of the first author, year of publication, country, severity status, study design, patient characteristics (ethnicity composition, gender, and mean age), comorbidities (diabetes, hyperlipidemia, hypertension, ischemic heart disease, heart failure, previous stroke, chronic kidney disease/end-stage renal disease, number of stroke patients per overall participants, any information relevant to strokes such as the location of stroke [arterial or venous]), types of stroke (ischemic or haemorrhagic), classification of stroke, mortality rate, and blood parameters. The aim of this current study is to perform a systematic review and meta-analysis concerning the epidemiological, clinical presentation, imaging characteristics, and laboratory findings related to both stroke and COVID-19 infection.
cord-288634-7g2kg2tz	2020	We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London''s regional stroke center, serving a population of 1.8 million in Ontario, Canada. 1,2 However, to date, no study has formally evaluated the impact of the coronavirus disease 19 (COVID-19) pandemic on the number of stroke patients being assessed in the ED, stroke admissions, or referrals to stroke prevention clinics in Canada. We, therefore, assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the ED, stroke unit admissions, and referrals to the urgent stroke prevention clinic at London Health Sciences Center University Hospital''s regional stroke center, serving a captive population of 1.8 million in Ontario, Canada.
cord-290216-kui8g3w6	2020	We analyzed statistically the number of transient ischemic attacks (TIA), ischemic strokes (IS) and hemorrhagic strokes (HS) between March 8 and May 2, 2020, the peak of the COVID-19 epidemic in Italy, and compared them with the identical period of 2019. We aimed at finding if and how the pandemic changed the incidence of ischemic and hemorrhagic strokes, and of transient ischemic attacks, at the Policlinic San Martino Hospital in Genoa, Italy, a regional "hub" and tertiary stroke care center. We analyzed statistically the observed numbers of transient ischemic attacks (TIA), ischemic strokes (IS) and hemorrhagic strokes (HS) at the Policlinic San Martino Hospital in Genoa, Italy, a regional "hub" and tertiary stroke care center. Incidence of TIA dropped significantly across almost all the study period; however, we did not observe a comparable, significant decrease of ischemic strokes.
cord-291413-cgec7150	2020	There are several challenges facing endovascular therapy for stroke, including shortages of medical staff who may be deployed for COVID-19 coverage or who may have contracted the infection and are thus quarantined, patients avoiding early medical care, a lack of personal protective equipment, delays in door-to-puncture time, anesthesia challenges, and a lack of high-intensity intensive care unit and stroke ward beds. As a leading regional neurovascular organization, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO) has established a task force composed of medical staff and physicians from different disciplines to establish guiding recommendations for the implementation of acute care pathways for various neurovascular emergencies during the current COVID-19 pandemic. As a leading regional neurovascular organization, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO) has established a task force composed of medical staff and physicians from different disciplines to establish guiding recommendations for the implementation of acute care pathways for various neurovascular emergencies during the current COVID-19 pandemic.
cord-294139-78c5h7la	2020	The frequency of common comorbidities (hypertension, dyslipidemia, diabetes mellitus, acute coronary syndrome /coronary artery disease), atrial fibrillation, stroke/transient ischemic attack, and malignancy), etiology of stroke if specified in the articles, and treatment (tissue plasminogen activator (tPA), mechanical thrombectomy, and anticoagulation were calculated by summation of events divided by the number of total patients from all studies whose information is available for each value. The salient findings of the study can be summarized as the followings; (1) the frequency of stroke in hospitalized COVID-19 patients was 1.1%, with mean days from COVID-19 symptom onset to stroke at 8 days, most commonly cryptogenic; (2) even with early case series with younger patients without a pre-existing medical condition, the mean age was 66.6, with slight male preponderance (65.6%); (3) stroke risk factors such as hypertension, dyslipidemia, and prior strokes were common as comorbidities; altered mental status was as frequent as 51.4 % as presenting symptom of stroke; (4) elevation of d-dimer and CRP were reproduced after synthesis of results; (5) case fatality rate was as high as 44.2% in patients with COVID-19 and stroke.
cord-297512-l9re9h4j	2011	authors: Sultana, Shehnaz; Venkata, Kolla K; Pranay, Penagaluru K; Usha, Rani P; Reddy, P.P. title: Interferon gamma (IFNγ) +874A/T gene polymorphism in South Indian ischemic stroke patients In the present study we have examined single nucleotide polymorphism in interferon gamma (IFNγ) at position +874A/T in South Indian ischemic stroke patients. In the present study we examined single nucleotide polymorphism in interferon gamma (IFNγ) at position +874A/T and found a significant association of "TT" genotype with ischemic stroke. A study carried out in Egyptian atopic patients showed a significant association of IFN-gamma gene polymorphism at position +874 A/T. 28 Study from China reported a significant association of IFN-gamma +874 A/T gene polymorphism and severe acute respiratory syndrome. 32 Our study found a significant association of ''TT'' genotype of IFN-γ +874 gene polymorphism and ischemic stroke in South Indian population.
cord-300742-hsfh4hw9	2020	We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. Variables of interest included hospitalization rate per week per 100,000 population (total ischemic and hemorrhagic strokes), male-to-female ratio, severity of stroke at admission [measured by the National Institutes of Health Stroke Scale (NIHSS)], functional status at admission and at discharge [defined by modified Rankin Scale (mRS) >2], presentation time (last known well to hospital admission), the proportion of patients who received intravenous tissue plasminogen activator (IV tPA) to total ischemic stroke incidence, door-to-needle time, door-to-CT time, hospital length-of-stay, and in-hospital mortality per admissions ratio (death before discharge).
cord-302062-wqmynngg	2020	title: Large artery ischemic stroke in severe COVID-19 Among hospitalized patients, stroke occurred a median of 5.5 days after admission (IQR 3.5-7.5). Only one patient met definite TOAST criteria for the diagnosis of large artery atherosclerotic infarction, and another one had a probably cardioembolic stroke due to preexisting atrial fibrillation (incomplete evaluation) [2] . None of the other six patients met diagnostic criteria for atherosclerotic, cardioembolic, or small vessel ischemic stroke (three with cryptogenic strokes, and three with incomplete evaluation). In this series of eight patients, although the evidence is limited by its observational nature and sample size, severe COVID-19 was associated with non-atherosclerotic, large artery ischemic strokes. If larger prospective studies confirm these observations, hypercoagulability associated with COVID-19 might be a contributory cause for large vessel ischemic stroke. Until robust evidence is available, the observation of intraarterial thrombi in the absence of significant atherosclerosis among these patients warrants consideration of individualized enhanced thromboprophylaxis for hospitalized patients with severe forms of SARS-CoV-2 infection.
cord-304636-houm2zcu	2020	• In the occurrence of new-onset neurological symptoms in COVID-19 patients, we should suspect an acute ischemic stroke and not assume that it is secondary to the respiratory syndrome (hypoxia). J o u r n a l P r e -p r o o f syndrome, neurological manifestations have been described in more than a third of patients, both in mild-moderate cases of the infection, as associated or as a complication in severe and critical cases. An unenhanced brain CT We, therefore, present an unusual case of simultaneous multivessel cerebral infarctions, without known extracerebral thrombotic events, in a patient with a moderate COVID-19 who did not develop acute respiratory distress syndrome or disseminated intravascular coagulation. It seems clear that patients with severe COVID-19 may suffer an ischaemic stroke or cerebral venous thrombosis because of the hypercoagulability that coincides with the critical illness [9] .
cord-307087-zsbmaieg	2020	In these articles, colleagues from China 3 and Spain 4 used data from stroke registries to compare the number of admissions during the pandemic surge and the corresponding period in the previous year, confirming a clear reduction in stroke admissions during this early phase of the COVID-19 outbreak. One study, based on data from a registry including 280 stroke centers throughout China, reported a 40% drop in stroke admissions during the pandemic surge. Unfortunately, although this registry includes a large network of certified stroke hospitals, the possibility that some missing patients with stroke were evaluated outside of these selected centers cannot be excluded. In addition, this theory is supported by data emerging from several countries suggesting a significant increase in mortality during the pandemic period that is unlikely to be explained by COVID-19 cases alone.
cord-309227-kgrfnkns	2020	title: Letter to the Editor regarding: Critical considerations for stroke management during COVID-19 pandemic by Inglis et al., Heart Lung Circ. To the Editor, We thank Inglis and colleagues for the recent CSANZ COVID-19 Cardiovascular Nursing Care Consensus Statement [1] and for highlighting important issues in cardiovascular and cerebrovascular disease nursing management during the COVID-19 pandemic. Stroke/TIA presentations, particularly among those with milder symptoms, have fallen substantially across the world during the pandemic, potentially resulting in more severe stroke events or disability from delayed treatment [2] [3] [4] . COVID-19 has negatively impacted hospital workflows and has led to redeployment of staff resources, including nurses who work in Stroke Units [2] . Without the care of specialist multidisciplinary teams in a dedicated stroke unit, patients face higher rates of complications, disability and mortality [2, 4, 5] . CSANZ COVID-19 cardiovascular nursing care consensus statement: Executive summary SSA statement of stroke care during the COVID-19 Stroke Society of Australasia
cord-309360-cpis1l4u	2020	Results: The association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. A recent study described the cases of 3 patients with COVID-19 who presented ischaemic stroke and antiphospholipid antibodies, in addition to elevated D-dimer levels and laboratory markers of systemic inflammation. 7 A recent study reported 3 cases of severe COVID-19 and ischaemic stroke; these patients presented antiphospholipid antibodies and laboratory findings compatible with systemic inflammation and coagulopathy. 19 In patients 1 and 2 of our series (Table 1) , the likelihood of a causal relationship between COVID-19 and stroke is high, as these patients presented laboratory markers of systemic inflammation and hypercoagulability and the aetiological study found no evident cause for ischaemic stroke.
cord-310105-a4fzp6bn	2020	CONCLUSION: Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients. The primary objective of this survey is to understand the changes in practices and policies related to acute stroke care during the COVID-19 pandemic. It is evident from our questionnaire that change in practices for acute stroke care including hospital transport guidelines and policies regarding interventional therapies may impact perceived stroke outcome or care.
cord-313539-fb5uzzua	2020	key: cord-313539-fb5uzzua authors: Venketasubramanian, Narayanaswamy; Hennerici, Michael G. cord_uid: fb5uzzua There has been a recent report of large artery ischaemic stroke among young patients with coronavirus disease 2019 (COVID-19) in the USA [1] . There have been other reports of cerebrovascular events among COVID patients in China [3] and another coronavirus infection that led to severe acute respiratory syndrome in Singapore [4] . Cardioembolic mechanisms may have a causative role, but intravenous immunoglobulin given for severe acute respiratory syndrome has also been implicated [4] . The authors have no conflicts of interest to declare. The authors did not receive any funding. Large-vessel stroke as a presenting feature of Covid-19 in the young Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study Large artery ischaemic stroke in severe acute respiratory syndrome (SARS)
cord-315162-v3g6eios	2020	METHODS: Our hospital developed an adapted ASU protocol which includes key elements for stroke unit care, can be utilized by staff not familiar with stroke care with minimal training and can be implemented in various settings. RESULTS: The adapted protocol has 3 categories of Acute monitoring (neurological observations, blood pressure and input-output monitoring, investigations and specific post-reperfusion issues), Stroke complications (focusing on 5 common complications) and Unified team (describing daily check-ins, patient education, communication, discharge planning and post-discharge support). Most hospitals have staff deployed outside their usual workplaces to cover emergency, isolation and screening services therefore disbanding the acute stroke unit team of multi-professional healthcare providers. An interprofessional team with medical, nursing and allied health backgrounds at the Singapore General Hospital developed an adapted ASU protocol that was easy to use and ensured that the key elements the acute stroke unit are maintained.
cord-321461-1s3y9kc5	2020	The novel coronavirus disease of 2019 (COVID-19) is caused by the binding of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to angiotensin-converting enzyme 2 (ACE2) receptors present on various locations such as the pulmonary alveolar epithelium and vascular endothelium. This case series describes three distinct yet similar scenarios of COVID-19 positive patients with several underlying comorbidities, wherein two of the patients presented to our hospital with sudden onset right-sided weakness, later diagnosed with ischemic stroke, and one patient who developed an acute intracerebral hemorrhage during his hospital stay. A 76-year-old woman with a past medical history of type-II diabetes mellitus, chronic obstructive pulmonary disease (COPD) on nocturnal 3 L/min home oxygen, obstructive sleep apnea on BiPAP (bilevel positive airway pressure) at home, hypertension, and dyslipidemia was diagnosed with COVID-19 infection eight days prior to her admission. Stroke (both ischemic and hemorrhagic) occurring in the setting of COVID-19 is reported to have a worse patient prognosis, with a substantially higher risk of in-hospital mortality [9] .
cord-322628-sh09ij0f	2007	title: Low-molecular-weight heparin compared with aspirin for the treatment of acute ischaemic stroke in Asian patients with large artery occlusive disease: a randomised study Exclusion criteria were as follows: prestroke modifi ed Rankin scale (mRS) score greater than 1; National Institutes of Health stroke scale (NIHSS) score greater than 22; history of intracerebral haemorrhage; known contraindication for the use of LMWH or aspirin (including haemorrhagic diathesis); patient on anticoagulation therapy (excluding aspirin) before the onset of stroke or defi nite indication for anticoagulation; sustained hypertension (blood pressure >220/>120 mm Hg) immediately before randomisation; coexisting systemic diseases such as terminal carcinoma, renal failure (creatinine >200 μmol/L, if known), cirrhosis, severe dementia or psychosis, brain tumour or other signifi cant non-ischaemic brain lesion on brain CT scan, atrial fi brillation on ECG (past or present); chronic rheumatic heart disease or metallic heart valve; thrombocytopenia (platelet count <100×10 9 /L, if known); or participation in another clinical trial.
cord-326626-ixxk6plf	2020	PATIENT AND METHODS: : To determine how COVID-19 infection may affect cerebrovascular disease, we evaluated the ischemic stroke sub-types, clinical course and outcomes prior to and during the pandemic in Qatar. The main objective of the present study is to compare the types of ischemic strokes in patients with or without confirmed COVID-19 infection to a busy tertiary care hospital during the pandemic. The Qatar Stroke Database prospectively collects information on all acute stroke patients For the present study, we evaluated the monthly rates of confirmed ischemic stroke admissions to the hospital for the last 4 months in 2019, prior to the onset of COVID-19 pandemic. Similar to previous case reports and case-controlled studies, from USA (10), Iran (26), Dubai (27) , France (28) and China (8), a third of our COVID-19 positive patients had severe disease, required ICU admissions, stayed longer in hospital and had fewer subjects with good outcome.
cord-327511-e3idvknz	2020	CONCLUSION: In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females. In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females. In this multicenter study of patients with stroke and SARS-CoV-2 infection admitted to comprehensive stroke centers in the Chicagoland area, males were more likely than females to have severe COVID-19 manifestations and worse ischemic stroke outcome at hospital discharge.
cord-330137-7w7wqy4h	2020	title: Time Is Brain: A Call to Action to Support Stroke Centers in Lowand Middle-Income Countries during the COVID-19 Pandemic Given the health infrastructure differences, economic differences, and previous differences in the burden of stroke between low-and middle-income (LMICs) versus high-income countries [2, 3] , LMICs, in particular, may face a considerable strain with a possible negative impact on the healthcare delivery system. We recommend health policymakers to authorize telemedicine technology in LMICs. Many important aspects of acute stroke management, from EMS dispatch to the selection of eligible cases for intravenous thrombolysis or endovascular therapy, can be performed via Telestroke [5] . Stroke centers need to practice 24/7 outpatient support using secured video-audio applications or at least telephone questionnaires to address vascular risk factors and assure medication compliance. LMICs need to be supported to continue fighting against stroke.
cord-332065-afq26621	2020	The primary endpoint of this study is to compare whether there was a significant difference in the proportion of patients in each reported racial category presenting with stroke during the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A statistically significant increase in the number of Black and Hispanic patients presenting with strokes was noted in California, Pacific hospitals, Western hospitals, and all hospitals in the United States during various months studied comparing 2020 to 2019. Given the recent pandemic and racial disparity among patients afflicted with SARS-CoV-2 and the possible link of this virus and cerebrovascular accidents (CVA), we sought to analyze whether there was a disparity for stroke patients presenting to hospitals during this time using the Get with the Guidelines (GWTG) National Stroke Database. The primary endpoint of this study is to compare whether there was a significant difference in the proportion of patients in each reported racial category presenting to our institution with stroke during the COVID-19 pandemic caused by SARS-CoV-2.
cord-334482-fpxd0ont	2020	7 Our group observed that five patients younger than 50 years who tested positive for SARSCoV2, some with no vascular risk factors, were admitted with large vessel stroke to our hospitals during a 2week period (March 23 to April 7, 2020) during the height of the pandemic in New York City (NY, USA). Furthermore, in patients presenting with large vessel stroke during the pandemic, data from the Mount Sinai Health System in New York City confirm that patients who tested positive for SARSCoV2 were significantly younger, with a mean age of 59 years (SD 13), than patients who tested negative for SARSCoV2, who had a mean age of 74 years (SD 17), 13 mirroring the findings of the Paris group. 16 Additionally, the report stated that two of 15 patients with large vessel stroke were younger than 50 years and without previous stroke risk factors.
cord-338628-7l9b5mqp	2020	We aimed to compare temporal trends in volume of acute stroke alerts, patient characteristics, telestroke care, and short-term outcomes preand post-SIP orders. CONCLUSIONS: In this cohort study, regional stroke alert and ischemic stroke discharge volumes decreased significantly in the early COVID-19 pandemic. We sought to determine whether a decrease in acute stroke presentations occurred during the early COVID-19 pandemic in Northern California and to assess differences in patient characteristics and hospital outcomes for those who presented for acute stroke evaluation during the pandemic compared with those who presented before the pandemic. Furthermore, patients presenting to the ED after May 9, 2020, were more similar to those in the pre-SIP cohort (January 1, 2019 to March 14, 2020) with regard to having a lower NIHSS score, higher percentage of stroke mimics, and fewer LVOs, but they were more similar to the post-SIP cohort (March 15, 2020 to May 9, 2020) with regard to arriving more by emergency medical services and having a lower Comorbidity Point Score, version 2, score (Tables I and II in the Data Supplement).
cord-345437-j3akzx10	2020	During the current COVID-19 pandemic there has been a decline in stroke admissions in centres all over the world [1, 2] and no doubt this phenomenon has contributed to the sharp fall in the number of patients attending Emergency Departments in England during March 2020 [3] . These are the patients most likely to decide to manage their stroke at home, perhaps for fear of the risk of contracting COVID-19 whilst in hospital. They are the most likely to have their neurological symptoms missed at a time of severe respiratory illness from the virus, or to be turned away from overstretched emergency services rather than being directed into the stroke pathway [4] . Figure 1 shows the distribution of stroke severities (using the National Institutes of Health Stroke Scale) in admissions to our Hyperacute Stroke Unit for two 40-day periods: before the decline in emergency admissions in England [3] (1st February to 12th March, blue triangles) and after it (1st April to 11th May 2020, red circles).
cord-353824-0oyvia6d	2020	Here we present a case of a patient with COVID-19 who presented with acute ischemic stroke in the absence of common risk factors for cerebrovascular accidents. A 70-year-old male patient, with no prior comorbidities, presented to the emergency department (ED) with fever, cough, and shortness of breath for four days, and altered level of consciousness and right-sided weakness with the sensory loss for one day. Here we report a case of a patient with COVID-19 who presented with acute ischemic stroke without any predisposing conventional risk factors for cerebrovascular accident. Older age, high sequential organ failure assessment (SOFA) score, cardiovascular diseases, secondary infections, ARDS, acute renal injury, lymphopenia, and elevated liver enzymes, CRP, ferritin, fibrin, and d-dimers are some of the factors in COVID-19 cases which can identify patients at risk of in-hospital mortality [13] . COVID-19 is an independent risk factor for acute ischemic stroke
cord-354866-5yzalrri	2020	During the baseline period up to February 25, 2020, the daily stroke admission rate was stable, with the slope of the regression describing the number of admissions over time equal to -0.33 (se = 1.21), not significantly different from 0 (p = 0.79), with daily admissions averaging 41. During the baseline period, the weekly stroke admission rate was stable, with the slope of the regression describing the number of admissions over time equal to -0.33 (se = 1.21) which does not significantly differ from 0 (p = 0.79). During the pandemic period, the number of arriving acute strokes decreased an average of 4.4 per week (i.e., the slope was -4.4, with se = 1.00), which differs significantly from 0 (p=0.005), with weekly admissions averaging 23, a 44% reduction versus baseline.
cord-355481-1avavlu3	2020	title: "Changes in Stroke Presentation in Neo-Covid Patients: A Case Study" A young male, COVID-19 positive, showed multiple scattered infarcts. Three weeks after discharge, his complaints of blurring of vision, "slowing in his thinking process, and frequent "blank outs" showed significant amelioration. The novel SARS-Cov-2, perhaps the most appropriate terminology in terms of being the closest in series of Covid viruses [2] , and acute respiratory distress as the major presenting symptom. The thrust presently, and rather appropriately is on collecting data, and basic, even secondary management in neo-COVID strokes. Neo-Covid''s ability to spread to different body tissues, including changes in antigenic behavior, one may expect, that stroke manifestations may differ too. A case of multiple embolic strokes, involving bilateral cerebral hemispheres is presented. This case is perhaps the first one that shows clear multiple thromboembolic stroke phenomenon, facial pigmentation, adding a new variant to neo COVID strokes. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young-Correspondence.