# ent

id: cord-010977-fwz7chzf
type: DNA
entity:
  homing endonucleases HE zinc finger nucleases ZFNs transcription activator like effector nucleases TALENs


id: cord-010977-fwz7chzf
type: PROTEIN
entity:
  molecular endotypes Bisphosphoglycerate mutase BPGM Transporter 2 ATP binding cassette subfamily B member TAP2


id: cord-010977-fwz7chzf
type: WORK_OF_ART
entity:
  Molecular and Genetic Analyses of Collagen Type IV Mutant Mouse Models of Spontaneous Intracerebral Hemorrhage


id: cord-010977-fwz7chzf
type: ORG
entity:
  status epilepticus Association of Genetic Variants Related to CETP Inhibitors and Statins With Lipoprotein Levels


id: cord-270475-mkpn9tz6
type: ORG
entity:
  COVID 19 Patients Awareness of an Increased Prevalence Circulation Acute Pulmonary Embolism Associated


id: cord-027259-f4sgobcz
type: PROTEIN
entity:
  endothelin interleukin 10 interleukin 8 interleukin 6 interleukin 4 interleukin 1 beta INR fibrogen vitamin D paratohormone urine Nitrites urine bilirubin


id: cord-252687-7084pfqm
type: PROTEIN
entity:
  serum interleukin 6 IL6 52 Huang et al conducted a study in which patients with severe infections admitted to the intensive care unit


id: cord-011483-zc6ve6le
type: ORG
entity:
  the National Advisory Neurological Disorders and Stroke Council National Institute of Neurological Disorders


id: cord-011483-zc6ve6le
type: DISEASE
entity:
  cerebral cortical injury pontine tegmentum midbrain basal forebrain hypothalamus and central thalamus putamen caudate


id: cord-304636-houm2zcu
type: PROTEIN
entity:
  L lactate dehydrogenase 341 IU L highsensitivity C reactive protein 3 86 mg dl serum ferritin 1107 μg L


id: cord-321461-1s3y9kc5
type: GGP
entity:
  Cureus DOI 10 7759 cureus 10157 sha 447f193e939f5268241c019b49c6a85700ee09d0 doc_id 321461 cord_uid 1s3y9kc5


id: cord-287742-y1j9x5ne
type: PROTEIN
entity:
  C reactive protein ferritin D dimer lactic acid dehydrogenase fibrinogen antiphospholipid procalcitonin interleukin6 troponin platelet


id: cord-287742-y1j9x5ne
type: CELL_LINE
entity:
  China 13 40 43 France 37 39 48 50 India 42 Iran 51 Italy 32 33 46 the Netherlands 34 Philippines 52 Spain 44 53 Turkey 58 UK 41 55


id: cord-290216-kui8g3w6
type: DISEASE
entity:
  Università degli Studi di Genova within the CRUI CARE Agreement We also acknowledge funding by the Policlinic


id: cord-103915-rzy7mejb
type: DNA
entity:
  anterioposterior AP mediolateral ML 1 AP 1 mm ML 1 5 mm 2 AP 0 5 mm ML 2 5 mm 3 AP 1 5 mm ML 2 5 mm 4 AP 0 5 mm ML 3 5 mm 5 AP 2 0 mm ML 3 5 mm 6 AP 0 5 mm ML 3 5


id: cord-310105-a4fzp6bn
type: ORG
entity:
  the New York Presbyterian Hospital Protected Code Stroke Hyperacute Stroke Management During the Coronavirus Disease Society of NeuroInterventional Surgery


id: cord-133894-wsnyq01s
type: GGP
entity:
  speci c terms 8 Sketch based 3D modeling is a rich ongoing area of research see survey by Olsen et al 2009 Typically these systems interpret 2D sketch inputs for various shape modeling tasks One could categorize these modeling approaches as single view akin to traditional pen on paper Andre and Saito 2011 Chen et al 2013 Schmidt et al 2009 Xu et al 2014 or multi view akin to 3D modeling with frequent view manipulation Bae et al 2008 Fan et al 2013 Fan et al 2004 Igarashi et al 1999 Nealen et al 2007 Single view techniques use perceptual insights and geometric properties of the 2D sketch to infer its depth in 3D while multi view techniques explicitly use view manipulation to specify 3D curve a ributes


id: cord-133894-wsnyq01s
type: ORG
entity:
  Substance Painter Association for Computing Machinery Experimental Evaluation of Sketching on Surfaces


id: cord-353824-0oyvia6d
type: DNA
entity:
  10310 sha d5f6a88712a8e8b616f9d745cdb4a67026f0ebbe doc_id 353824 cord_uid 0oyvia6d Coronavirus disease 2019 COVID 19


id: cord-353824-0oyvia6d
type: GGP
entity:
  Cureus DOI 10 7759 cureus 10310 sha d5f6a88712a8e8b616f9d745cdb4a67026f0ebbe doc_id 353824 cord_uid 0oyvia6d Coronavirus disease 2019 COVID 19


id: cord-006182-kck5e1ry
type: DNA
entity:
  CAT and MAT groups p 0 341 0 593 and 0 503 respectively In overweight patients body mass index prevented dramatic reductions in PaO2 and SaO2 p 0 05


id: cord-006182-kck5e1ry
type: GGP
entity:
  2 9 1 3 6 6 p 0 0077 and midline shift 5mm 2 3 1 1 4 9 p 0 0219 Rotterdam score was significantly higher in patients with unfavorable outcome 3 7 vs 4 5 p 0


id: cord-006182-kck5e1ry
type: WORK_OF_ART
entity:
  Trends and Predictors of In hospital Mortality for Status Epilepticus National Inpatient Sample Study Head or


id: cord-006870-f5w6fw6q
type: DISEASE
entity:
  pneumonia venous thromboembolism pulmonary embolism sepsis septic shock pulmonary edema gastrointestinal bleeding


# bib

id: cord-006182-kck5e1ry
title: 17th Annual Meeting, Neurocritical Care Society, October 15–18, 2019, Vancouver, Canada
author: nan
date: 2019-10-01
txt: ./txt/cord-006182-kck5e1ry.txt
cache: ./cache/cord-006182-kck5e1ry.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100118/
doi: 10.1007/s12028-019-00857-7
abstract: nan
summary:
  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.


id: cord-006870-f5w6fw6q
title: Abstracts Presented at the Neurocritical Care Society (NCS) 15th Annual Meeting
author: nan
date: 2017-09-19
txt: ./txt/cord-006870-f5w6fw6q.txt
cache: ./cache/cord-006870-f5w6fw6q.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103238/
doi: 10.1007/s12028-017-0465-9
abstract: nan
summary:
  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.


id: cord-010977-fwz7chzf
title: Translational Genomics in Neurocritical Care: a Review
author: Myserlis, Pavlos
date: 2020-02-20
txt: ./txt/cord-010977-fwz7chzf.txt
cache: ./cache/cord-010977-fwz7chzf.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223188/
doi: 10.1007/s13311-020-00838-1
summary:
  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.

abstract:
  Translational genomics represents a broad field of study that combines genome and transcriptome-wide studies in humans and model systems to refine our understanding of human biology and ultimately identify new ways to treat and prevent disease. The approaches to translational genomics can be broadly grouped into two methodologies, forward and reverse genomic translation. Traditional (forward) genomic translation begins with model systems and aims at using unbiased genetic associations in these models to derive insight into biological mechanisms that may also be relevant in human disease. Reverse genomic translation begins with observations made through human genomic studies and refines these observations through follow-up studies using model systems. The ultimate goal of these approaches is to clarify intervenable processes as targets for therapeutic development. 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. Further, we highlight approaches in the field that could be applied in neurocritical care to improve our ability to identify new treatment modalities as well as to provide important information to patients about risk and prognosis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13311-020-00838-1) contains supplementary material, which is available to authorized users.


id: cord-011483-zc6ve6le
author: Leclerc, Angela M.
date: 2020-05-20
txt: ./txt/cord-011483-zc6ve6le.txt
cache: ./cache/cord-011483-zc6ve6le.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239352/
doi: 10.1007/s12028-020-00986-4
summary:
  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).

title:
  Amantadine and Modafinil as Neurostimulants Following Acute Stroke: A Retrospective Study of Intensive Care Unit Patients

abstract:
  BACKGROUND/OBJECTIVE: Neurostimulants may improve or accelerate cognitive and functional recovery after intracerebral hemorrhage (ICH), ischemic stroke (IS), or subarachnoid hemorrhage (SAH), but few studies have described their safety and effectiveness in the intensive care unit (ICU). The objective of this study was to describe amantadine and modafinil administration practices during acute stroke care starting in the ICU and to evaluate safety and effectiveness. METHODS: Consecutive adult ICU patients treated with amantadine and/or modafinil following acute non-traumatic IS, ICH, or SAH were evaluated. 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. Patients were considered responders if they met two of three criteria within 9 days of neurostimulant initiation: increase in Glasgow coma scale (GCS) score ≥ 3 points from pre-treatment baseline, improved wakefulness or participation documented in caregiver notes, or clinical improvement documented in physical or occupational therapy notes. Potential confounders of the effectiveness assessment and adverse drug effects were also recorded. RESULTS: A total of 87 patients were evaluable during the 3.7-year study period, including 41 (47%) with ICH, 29 (33%) with IS, and 17 (20%) with SAH. The initial neurostimulant administered was amantadine in 71 (82%) patients, modafinil in 13 (15%), or both in 3 (3%) patients. Neurostimulants were initiated a median of 7 (4.25, 12.75) days post-stroke (range 1–27 days) for somnolence (77%), not following commands (32%), lack of eye opening (28%), or low GCS (17%). The most common starting dose was 100 mg twice daily for both amantadine (86%) and modafinil (54%). Of the 79 patients included in the effectiveness evaluation, 42 (53%) were considered responders, including 34/62 (55%) receiving amantadine monotherapy and 8/24 (33%) receiving both amantadine and modafinil at the time they met the definition of a responder. No patient receiving modafinil monotherapy was considered a responder. The median time from initiation to response was 3 (2, 5) days. Responders were more frequently discharged home or to acute rehabilitation compared to non-responders (90% vs 62%, p = 0.006). Among survivors, 63/72 (88%) were prescribed a neurostimulant at hospital discharge. The most common potential adverse drug effect was sleep disruption (16%). CONCLUSIONS: Neurostimulant administration during acute stroke care may improve wakefulness. Future controlled studies with a neurostimulant administration protocol, prospective evaluation, and discretely defined response and safety criteria are needed to confirm these encouraging findings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12028-020-00986-4) contains supplementary material, which is available to authorized users.


id: cord-016906-ynfb10pq
title: Modification of Bone Marrow Stem Cells for Homing and Survival During Cerebral Ischemia
author: Tang, Yaohui
date: 2016-12-15
txt: ./txt/cord-016906-ynfb10pq.txt
cache: ./cache/cord-016906-ynfb10pq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121342/
doi: 10.1007/978-981-10-2929-5_9
summary:
  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.

abstract:
  Over the last decade, major advances have been made in stem cell-based therapy for ischemic stroke, which is one of the leading causes of death and disability worldwide. Various stem cells from bone marrow, such as mesenchymal stem cells (MSCs), hematopoietic stem cells (HSCs), and endothelial progenitor cells (EPCs), have shown therapeutic potential for stroke. Concomitant with these exciting findings are some fundamental bottlenecks that must be overcome in order to accelerate their clinical translation, including the low survival and engraftment caused by the harsh microenvironment after transplantation. In this chapter, strategies such as gene modification, hypoxia/growth factor preconditioning, and biomaterial-based methods to improve cell survival and homing are summarized, and the potential strategies for their future application are also discussed.


id: cord-027259-f4sgobcz
title: Stroke ICU Patient Mortality Day Prediction
author: Metsker, Oleg
date: 2020-05-23
txt: ./txt/cord-027259-f4sgobcz.txt
cache: ./cache/cord-027259-f4sgobcz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303676/
doi: 10.1007/978-3-030-50423-6_29
summary:
  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 .

abstract:
  This article presents a study on development of methods for analysis of data reflecting the process of treatment of stroke inpatients to predict clinical outcomes at the emergency care unit. The aim of this work is to develop models for the creation of validated risk scales for early intravenous stroke with minimum number of parameters with maximum prognostic accuracy and possibility to calculate the time of “expected intravenous stroke mortality”. The study of experience in the development and use of medical information systems allows us to state the insufficient ability of existing models for adequate data analysis, weak formalization and lack of system approach in the collection of diagnostic data, insufficient personalization of diagnostic data on the factors determining early intravenous stroke mortality. In our study we divided patients into 3 subgroups according to the time of death - up to 1 day, 1 to 3 days, and 4 to 10 days. 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. The target classes in training were “mortality rate of 1 day”, “mortality rate of 1–3 days”, “mortality rate from 4 days”. AUC ROC of trained models reached 91% for the method of random forest. The results of interpretation of decision trees and calculation of significance of predictors of built-in methods of random forest coincide that can prove to correctness of calculations.


id: cord-032820-l0vkq0j3
title: Incidence and pathophysiologic mechanisms of stroke in the COVID-19 pandemic: the dilemma
author: Mohamed, Sherif
date: 2020-09-29
txt: ./txt/cord-032820-l0vkq0j3.txt
cache: ./cache/cord-032820-l0vkq0j3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522925/
doi: 10.1186/s43168-020-00033-y
summary:
  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

abstract:
  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. MAIN BODY: Many pathophysiologic and immunologic mechanisms have been implicated in stroke occurring among patients with COVID-19. 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. In this brief report, we try to discuss these issues. CONCLUSIONS: Although the control of COVID-19 is of crucial importance, at the same time, the management of stroke must not be neglected. Therefore, introducing care for critical conditions such as stroke, and providing strategies to ensure this proceeds, is a priority even at the time of the pandemic.


id: cord-034257-kl2ccmz5
author: de Jonge, Jeroen C.
date: 2020-10-26
txt: ./txt/cord-034257-kl2ccmz5.txt
cache: ./cache/cord-034257-kl2ccmz5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586648/
doi: 10.1186/s13063-020-04717-0
summary:
  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.

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

abstract:
  RATIONALE: Aspiration, infections, and fever are common in the first days after stroke, especially in older patients. The occurrence of these complications has been associated with an increased risk of death or dependency. 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. DISCUSSION: This statistical analysis plan provides a technical description of the statistical methodology and unpopulated tables and figures. The paper is written prior to data lock and unblinding of treatment allocation. TRIAL REGISTRATION: ISRCTN registry ISRCTN82217627. Registered on 22 September 2015. The trial was prospectively registered.


id: cord-103915-rzy7mejb
author: Duricki, Denise A.
date: 2018-07-11
txt: ./txt/cord-103915-rzy7mejb.txt
cache: ./cache/cord-103915-rzy7mejb.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1101/367573
doi: 10.1101/367573
summary:
  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.

title:
  Corticospinal neuroplasticity and sensorimotor recovery in rats treated by infusion of neurotrophin-3 into disabled forelimb muscles started 24 h after stroke

abstract:
  Stroke often leads to arm disability and reduced responsiveness to stimuli on the other side of the body. Neurotrophin-3 (NT3) is made by skeletal muscle during infancy but levels drop postnatally and into adulthood. It is essential for the survival and wiring-up of sensory afferents from muscle. 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. Here, to move this therapy one step nearer to the clinic, we set out to test the hypothesis that intramuscular infusion of NT3 protein could improve sensorimotor recovery after ischemic cortical stroke in adult rats. To simulate a clinically-feasible time-to-treat, twenty-four hours later rats were randomized to receive NT3 or vehicle by infusion into triceps brachii for four weeks using implanted minipumps. NT3 increased the accuracy of forelimb placement during walking on a horizontal ladder and increased use of the affected arm for lateral support during rearing. NT3 also reversed sensory deficits on the affected forearm. There was no evidence of forepaw sensitivity to cold stimuli after stroke or NT3 treatment. MRI confirmed that treatment did not induce neuroprotection. Functional MRI during low threshold electrical stimulation of the affected forearm showed an increase in peri-infarct BOLD signal with time in both stroke groups and indicated that neurotrophin-3 did not further increase peri-infarct BOLD signal. Rather, NT3 induced spinal neuroplasticity including sprouting of the spared corticospinal and serotonergic pathways. Neurophysiology showed that NT3 treatment increased functional connectivity between the corticospinal tracts and spinal circuits controlling muscles on the treated side. After intravenous injection, radiolabelled NT3 crossed from bloodstream into the brain and spinal cord in adult mice with or without strokes. Our results show that delayed, peripheral infusion of neurotrophin-3 can improve sensorimotor function after ischemic stroke. Phase I and II clinical trials of NT3 (for constipation and neuropathy) have shown that peripheral, high doses are safe and well tolerated, which paves the way for NT3 as a therapy for stroke.


id: cord-133894-wsnyq01s
title: Mid-Air Drawing of Curves on 3D Surfaces in AR/VR
author: Arora, Rahul
date: 2020-09-18
txt: ./txt/cord-133894-wsnyq01s.txt
cache: ./cache/cord-133894-wsnyq01s.txt
extension: .txt
mime: text/plain
url: https://arxiv.org/pdf/2009.09029v1.pdf
doi: nan
summary:
  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) .

abstract:
  Complex 3D curves can be created by directly drawing mid-air in immersive environments (AR/VR). Drawing mid-air strokes precisely on the surface of a 3D virtual object however, is difficult; necessitating a projection of the mid-air stroke onto the user"intended"surface curve. We present the first detailed investigation of the fundamental problem of 3D stroke projection in AR/VR. An assessment of the design requirements of real-time drawing of curves on 3D objects in AR/VR is followed by the definition and classification of multiple techniques for 3D stroke projection. We analyze the advantages and shortcomings of these approaches both theoretically and via practical pilot testing. We then formally evaluate the two most promising techniques spraycan and mimicry with 20 users in VR. The study shows a strong qualitative and quantitative user preference for our novel stroke mimicry projection algorithm. We further illustrate the effectiveness and utility of stroke mimicry, to draw complex 3D curves on surfaces for various artistic and functional design applications.


id: cord-252687-7084pfqm
title: Ischemic Stroke among the Symptoms Caused by the COVID-19 Infection
author: Szelenberger, Rafal
date: 2020-08-19
txt: ./txt/cord-252687-7084pfqm.txt
cache: ./cache/cord-252687-7084pfqm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32825182/
doi: 10.3390/jcm9092688
summary:
  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.

abstract:
  The 2019 global pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been declared a public health emergency of international concern by the World Health Organization (WHO). The WHO recognized the spread of COVID-19 as a pandemic on 11 March 2020. Based on statistics from 10 August 2020, more than 20.2 million cases of COVID-19 have been reported resulting in more than 738,000 deaths. This completely new coronavirus has spread worldwide in a short period, causing economic crises and healthcare system failures worldwide. Initially, it was thought that the main health threat was associated with respiratory system failures, but since then, SARS-CoV-2 has been linked to a broad spectrum of symptoms indicating neurological manifestations, including ischemic stroke. Current knowledge about SARS-CoV-2 and its complications is very limited because of its rapidly evolving character. However, further research is undoubtedly necessary to understand the causes of neurological abnormalities, including acute cerebrovascular disease. The viral infection is inextricably associated with the activation of the immune system and the release of pro-inflammatory factors, that can stimulate the host organism to defend itself. However, the body’s immune response is a double-edged sword that on one hand, destroys the virus but also disrupts the homeostasis leading to serious complications, including thrombosis. Numerous studies have linked coagulopathies with COVID-19, however, there is great uncertainty regarding it functions on the molecular level. In this review, a detailed insight into the biological processes associated with ischemic stroke in COVID-19 patients and suggest a possible explanation for this phenomenon is provided.


id: cord-254423-jz6hoxk1
title: Impact of COVID-19 on Patient Behavior to Stroke Symptoms in China
author: Song, Lili
date: 2020-10-08
txt: ./txt/cord-254423-jz6hoxk1.txt
cache: ./cache/cord-254423-jz6hoxk1.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1159/000511394
doi: 10.1159/000511394
abstract: nan
summary:
  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]).


id: cord-255604-hnbzidf3
title: Approaches to global stroke care during the COVID-19 pandemic
author: Liu, Liping
date: 2020-05-23
txt: ./txt/cord-255604-hnbzidf3.txt
cache: ./cache/cord-255604-hnbzidf3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32447298/
doi: 10.1136/svn-2020-000429
abstract: nan
summary:
  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:


id: cord-257074-baiqcoao
title: The impact of SARS‐Cov‐2 pandemic on stroke care: A warning message
author: Bersano, Anna
date: 2020-06-11
txt: ./txt/cord-257074-baiqcoao.txt
cache: ./cache/cord-257074-baiqcoao.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1111/ene.14394
doi: 10.1111/ene.14394
summary:
  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

abstract:
  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.


id: cord-257433-qgkwylmk
author: Candeloro, Elisa
date: 2020-10-15
txt: ./txt/cord-257433-qgkwylmk.txt
cache: ./cache/cord-257433-qgkwylmk.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33178094/
doi: 10.3389/fneur.2020.01029
summary:
  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.

title:
  An Example of a Stroke Unit Reshaping in the Context of a Regional Hub and Spoke System in the COVID-19 Era

abstract:
  During the COVID-19 outbreak, the Neurology and Stroke Unit (SU) of the hospital of Varese had to serve as a cerebrovascular hub, meaning that the referral area for the unit doubled. The number of beds in the SU was increased from 4 to 8. We took advantage of the temporary suspension of the out-patient clinic and reshaped our activity to guarantee the 24/7 availability of recombinant tissue Plasminogen Activator (rtPA) intravenous therapy (IVT) in the SU, and to ensure we were able to admit patients to the SU as soon as they completed endovascular treatment (EVT). In 42 days, 46 stroke patients were admitted to our hospital, and 34.7% of them underwent IVT and/or EVT, which means that we treated 0.38 patients per day; in the baseline period from 2016 to 2018, these same figures had been 23.5% and 0.23, respectively. The mean values of the door-to-first CT/MRI and the door-to-groin puncture, but not of the onset-to-door and the door-to-needle periods were slightly but significantly longer than those observed in the baseline period in 276 patients. On an individual basis, only one patient exceeded the door-to-groin puncture time limit computed from the baseline period by about 10 min. None of the patients had a major complication following the procedures. None of the patients was or became SARS-CoV2 positive. In conclusion, we were able to manage the new hub-and-spoke system safely and without significant delays. The reshaping of the SU was made possible by the significant reduction of out-patient activity. The consequences of this reduction are still unknown but eventually, this emergency will suggest ways to reconsider the management and the allocation of health system resources.


id: cord-259845-kjbhmsqr
title: COVID-19-Related Stroke: Barking up the Wrong Tree?
author: Morelli, Nicola
date: 2020-06-11
txt: ./txt/cord-259845-kjbhmsqr.txt
cache: ./cache/cord-259845-kjbhmsqr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1159/000509002
doi: 10.1159/000509002
abstract: nan
summary:
  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


id: cord-267402-kca05rvz
title: Preceding infection and risk of stroke: An old concept revived by the COVID-19 pandemic
author: South, Kieron
date: 2020-07-24
txt: ./txt/cord-267402-kca05rvz.txt
cache: ./cache/cord-267402-kca05rvz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32618498/
doi: 10.1177/1747493020943815
summary:
  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.

abstract:
  Anecdotal reports and clinical observations have recently emerged suggesting a relationship between COVID-19 disease and stroke, highlighting the possibility that infected individuals may be more susceptible to cerebrovascular events. In this review we draw on emerging studies of the current pandemic and data from earlier, viral epidemics, to describe possible mechanisms by which SARS-CoV-2 may influence the prevalence of stroke, with a focus on the thromboinflammatory pathways, which may be perturbed. Some of these potential mechanisms are not novel but are, in fact, long-standing hypotheses linking stroke with preceding infection that are yet to be confirmed. The current pandemic may present a renewed opportunity to better understand the relationship between infection and stroke and possible underlying mechanisms.


id: cord-270475-mkpn9tz6
title: COVID-19 and Stroke: incidence and etiological description in a high-volume center.
author: Requena, Manuel
date: 2020-08-05
txt: ./txt/cord-270475-mkpn9tz6.txt
cache: ./cache/cord-270475-mkpn9tz6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105225
doi: 10.1016/j.jstrokecerebrovasdis.2020.105225
summary:
  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.

abstract:
  BACKGROUND: An increased rate of thrombotic events has been associated to Coronavirus Disease 19 (COVID-19) with a variable rate of acute stroke. Our aim is to uncover the rate of acute stroke in COVID-19 patients and identify those cases in which a possible causative relationship could exist. METHODS: We performed a single-center analysis of a prospective mandatory database. We studied all patients with confirmed COVID-19 and stroke diagnoses from March 2(nd) to April 30(th). Demographic, clinical, and imaging data were prospectively collected. Final diagnosis was determined after full diagnostic work-up unless impossible due to death. RESULTS: Of 2050 patients with confirmed SARS-CoV-2 infection, 21 (1.02%) presented an acute ischemic stroke 21 and 4 (0.2%) suffered an intracranial hemorrhage. After the diagnostic work-up, in 60.0% ischemic and all hemorrhagic strokes patients an etiology non-related with COVID-19 was identified. Only in 6 patients the stroke cause was considered possibly related to COVID-19, all of them required mechanical ventilation before stroke onset. Ten patients underwent endovascular treatment; compared with patients who underwent EVT in the same period, COVID-19 was an independent predictor of in-hospital mortality (50% versus 15%; Odds Ratio, 6.67; 95% CI, 1.1-40.4; p 0.04). CONCLUSIONS: The presence of acute stroke in patients with COVID-19 was below 2% and most of them previously presented established stroke risk factors. Without other potential cause, stroke was an uncommon complication and exclusive of patients with a severe pulmonary injury. The presence of COVID-19 in patients who underwent EVT was an independent predictor of in-hospital mortality.


id: cord-271168-a9sf8f4p
title: Break in the Stroke Chain of Survival Due to COVID-19
author: Montaner, Joan
date: 2020-06-08
txt: ./txt/cord-271168-a9sf8f4p.txt
cache: ./cache/cord-271168-a9sf8f4p.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32466738/
doi: 10.1161/strokeaha.120.030106
summary:
  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.

abstract:
  BACKGROUND AND PURPOSE: Emergency measures to treat patients with coronavirus 2019 (COVID-19) and contain the outbreak is the main priority in each of our hospitals; however, these measures are likely to result in collateral damage among patients with other acute diseases. Here, we investigate whether the COVID-19 pandemic affects acute stroke care through interruptions in the stroke chain of survival. METHODS: A descriptive analysis of acute stroke care activity before and after the COVID-19 outbreak is given for a stroke network in southern Europe. 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. RESULTS: Following confinement of the population, our stroke unit activity decreased sharply, with a 25% reduction in admitted cases (mean number of 58 cases every 15 days in previous months to 44 cases in the 15 days after the outbreak, P<0.001). Consultations to the telestroke network declined from 25 every 15 days before the outbreak to 7 after the outbreak (P<0.001). The increasing trend in the prehospital diagnosis of stroke activated by 911 calls stopped abruptly in the region, regressing to 2019 levels. The mean number of stroke codes dispatched to hospitals decreased (78% versus 57%, P<0.001). Time of arrival from symptoms onset to stroke units was delayed >30 minutes, reperfusion therapy cases fell, and door-to-needle time started 16 minutes later than usual. CONCLUSIONS: The COVID-19 pandemic is disruptive for acute stroke pathways. Bottlenecks in the access and delivery of patients to our secured stroke centers are among the main challenges. It is critical to encourage patients to continue seeking emergency care if experiencing acute stroke symptoms and to ensure that emergency professionals continue to use stroke code activation and telestroke networks.


id: cord-274810-vfr1g9kp
author: Lee, Meng
date: 2020-05-06
txt: ./txt/cord-274810-vfr1g9kp.txt
cache: ./cache/cord-274810-vfr1g9kp.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32413768/
doi: 10.1016/j.jns.2020.116883
abstract: nan
summary:
  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.

title:
  Covert COVID-19 complications: Continuing the use of evidence-based drugs to minimize potentially lethal indirect effects of the pandemic in stroke patients


id: cord-277011-0khsxhwv
title: Stroke care in Europe during the COVID‐19 pandemic
author: Aguiar de Sousa, Diana
date: 2020-06-16
txt: ./txt/cord-277011-0khsxhwv.txt
cache: ./cache/cord-277011-0khsxhwv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32548937/
doi: 10.1111/ene.14401
summary:
  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

abstract:
  In view of finite health care resources and the ethical principle of distributive justice, healthcare systems across Europe have been adapted to provide care for patients with coronavirus disease 2019 (COVID‐19) while not neglecting other serious medical emergencies. Policies to contain disease spreading and to preserve usual health care systems as much as possible differ considerably between countries.


id: cord-280733-d44se0v3
author: Aguiar de Sousa, Diana
date: 2020-06-10
txt: ./txt/cord-280733-d44se0v3.txt
cache: ./cache/cord-280733-d44se0v3.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33072876/
doi: 10.1177/2396987320933746
summary:
  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.

title:
  Maintaining stroke care in Europe during the COVID-19 pandemic: Results from an international survey of stroke professionals and practice recommendations from the European Stroke Organisation

abstract:
  INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has been placing an overwhelming burden on health systems, thus threatening their ability to operate effectively for acute conditions in which treatments are highly time sensitive, such as cerebrovascular disorders and myocardial infarction. 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. METHODS: Cross-sectional, web-based survey, conducted from 26 March through 1 April 2020 among stroke care providers, focused on reorganisation of health services, the delivery of acute and post-acute stroke care and the availability of personal protective equipment. RESULTS: A total of 426 stroke care providers from 55 countries completed the survey, most of whom worked in Europe (n = 375, 88%) and were stroke physicians/neurologists (n = 334, 78%). 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. The areas considered as being most affected were acute care and rehabilitation. Most professionals had to adapt their activities and schedules and more than half reported shortage of protective equipment. DISCUSSION: Strategies to maintain availability of stroke care during the COVID-19 outbreak are crucial to prevent indirect mortality and disability due to suboptimal care. CONCLUSION: European Stroke Organisation proposes a set of targeted actions for decision makers facing this exceptional situation.


id: cord-282956-f7if9e5q
title: SARS2-CoV-2 and Stroke in a New York Healthcare System
author: Yaghi, Shadi
date: 2020-05-26
txt: ./txt/cord-282956-f7if9e5q.txt
cache: ./cache/cord-282956-f7if9e5q.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1161/strokeaha.120.030335
doi: 10.1161/strokeaha.120.030335
summary:
  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.

abstract:
  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. However, there is limited data on the clinical characteristics, stroke mechanism, and outcomes of patients who have a stroke and COVID-19. 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. We compared the clinical characteristics of stroke patients with a concurrent diagnosis of COVID-19 to stroke patients without COVID-19 (contemporary controls). In addition, we compared patients to a historical cohort of patients with ischemic stroke discharged from our hospital system between March 15, 2019, and April 15, 2019 (historical controls). RESULTS: During the study period in 2020, out of 3556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to contemporary controls (30.4%, P=0.003) and historical controls (25.0%, P<0.001). When compared with contemporary controls, COVID-19 positive patients had higher admission National Institutes of Health Stroke Scale score and higher peak D-dimer levels. When compared with historical controls, COVID-19 positive patients were more likely to be younger men with elevated troponin, higher admission National Institutes of Health Stroke Scale score, and higher erythrocyte sedimentation rate. Patients with COVID-19 and stroke had significantly higher mortality than historical and contemporary controls. CONCLUSIONS: We observed a low rate of imaging-confirmed ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased. Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19.


id: cord-287742-y1j9x5ne
title: Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis
author: Lee, Kai Wei
date: 2020-10-06
txt: ./txt/cord-287742-y1j9x5ne.txt
cache: ./cache/cord-287742-y1j9x5ne.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3389/fneur.2020.579070
doi: 10.3389/fneur.2020.579070
summary:
  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.

abstract:
  Background: As the world witnessed the devastation caused by the coronavirus disease 2019 (COVID-19) outbreak, a growing body of literature on COVID-19 is also becoming increasingly available. Stroke has increasingly been reported as a complication of COVID-19 infection. However, a systematic synthesis of the available data has not been conducted. 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. Methods: We systematically searched Medline, Cinahl, and PubMed for studies related to stroke and COVID-19 from inception up to June 4, 2020. We selected cohort studies, case series, and case reports that reported the occurrence of stroke in COVID-19 patients. A fixed-effects model was used to estimate the pooled frequency of stroke in COVID-19 patients with a 95% confidence interval (CI). Results: Twenty-eight studies were included in the systematic review and seven studies for the meta-analysis. The pooled frequency of stroke in COVID-19 patients was 1.1% (95% CI: 0.8, 1.3). The heterogeneity was low (I(2) = 0.0%). Even though the frequency of stroke among patients having COVID-19 infection was low, those with concomitant COVID-19 infection and stroke suffered from a more severe infection and eventually had a poorer prognosis with a higher mortality rate (46.7%) than COVID-19 alone. Many COVID-19 patients shared the common traditional risk factors for stroke. We noted that ischemic stroke involving the anterior circulation with large vessels occlusion is the most common type of stroke with more strokes seen in multi-territorial regions, suggesting systemic thromboembolism. An elevated level of D-dimers, C-reactive protein, ferritin, lactic acid dehydrogenase, troponin, ESR, fibrinogen, and a positive antiphospholipid antibody were also noted in this review. Conclusions: The occurrence of stroke in patients with COVID-19 infection is uncommon, but it may pose as an important prognostic marker and indicator of severity of infection, by causing large vessels occlusion and exhibiting a thrombo-inflammatory vascular picture. Physicians should be made aware and remain vigilant on the possible two-way relationship between stroke and COVID-19 infection. The rate of stroke among patients with COVID-19 infection may increase in the future as they share the common risk factors.


id: cord-288634-7g2kg2tz
title: COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals
author: Bres Bullrich, Maria
date: 2020-05-26
txt: ./txt/cord-288634-7g2kg2tz.txt
cache: ./cache/cord-288634-7g2kg2tz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32450927/
doi: 10.1017/cjn.2020.101
summary:
  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.

abstract:
  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. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.


id: cord-290216-kui8g3w6
author: Balestrino, Maurizio
date: 2020-10-15
txt: ./txt/cord-290216-kui8g3w6.txt
cache: ./cache/cord-290216-kui8g3w6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s11739-020-02522-w
doi: 10.1007/s11739-020-02522-w
summary:
  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.

title:
  Request of hospital care dropped for TIA but remained stable for stroke during COVID-19 pandemic at a large Italian university hospital

abstract:
  Reduced incidence of stroke during COVID-19 pandemic was sometimes reported. While decrease in stroke incidence and fear of patients to go to the hospitals were sometimes invoked to explain this decrease, reduction in urban pollution was also hypothesized as a possible cause. We investigated statistically the incidence of ischemic and hemorrhagic stroke, and of transient ischemic attacks, at a large Italian tertiary stroke center during the pandemic. 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 also analyzed the concentration of small particulate matter (PM(10)) in 2019 and 2020, to see if it could account for modified incidence of strokes or TIA. We found a large, significant drop in TIA (− 51%) during the pandemic compared to the same period of 2019. By contrast, the number of HS was identical, and IS showed a not significant − 24% decrease. PM(10) concentration, already low in 2019, did not further decrease in 2020. Patients kept seeking hospital care when experiencing permanent neurological symptoms (stroke), but they tended not go to the hospital when their symptoms were transient (TIA). The fact that we did not observe a significant decrease in strokes may be explained by the fact that in our city the concentration of small particulate matter did not change compared to 2019.


id: cord-291413-cgec7150
author: Al-Jehani, Hosam
date: 2020-08-25
txt: ./txt/cord-291413-cgec7150.txt
cache: ./cache/cord-291413-cgec7150.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32982938/
doi: 10.3389/fneur.2020.00928
summary:
  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.

title:
  MENA-SINO Consensus Statement on Implementing Care Pathways for Acute Neurovascular Emergencies During the COVID-19 Pandemic

abstract:
  In the unprecedented current era of the COVID-19 pandemic, challenges have arisen in the management and interventional care of patients with acute stroke and large vessel occlusion, aneurysmal subarachnoid hemorrhage, and ruptured vascular malformations. 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. This consensus recommendation was achieved through a series of meetings to finalize the recommendation.


id: cord-294139-78c5h7la
title: Clinical Characteristics of Stroke with COVID-19: A Systematic Review and Meta-Analysis
author: Yamakawa, Mai
date: 2020-08-29
txt: ./txt/cord-294139-78c5h7la.txt
cache: ./cache/cord-294139-78c5h7la.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105288
doi: 10.1016/j.jstrokecerebrovasdis.2020.105288
summary:
  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.

abstract:
  BACKGROUND: The coronavirus disease 2019 (COVID-19) potentially increases the risk of thromboembolism and stroke. Numerous case reports and retrospective cohort studies have been published with mixed characteristics of COVID-19 patients with stroke regarding age, comorbidities, treatment, and outcome. We aimed to depict the frequency and clinical characteristics of COVID-19 patients with stroke. METHODS: PubMed and EMBASE were searched on June 10, 2020, to investigate COVID-19 and stroke through retrospective cross-sectional studies, case series/reports according to PRISMA guidelines. Study-specific estimates were combined using one-group meta-analysis in a random-effects model. RESULTS: 10 retrospective cohort studies and 16 case series/reports were identified including 183 patients with COVID-19 and stroke. The frequency of detected stroke in hospitalized COVID-19 patients was 1.1% ([95% confidential interval (CI)]: [0.6-1.6], I(2)=62.9%). Mean age was 66.6 ([58.4-74.9], I(2)=95.1%), 65.6% was male (61/93 patients). Mean days from symptom onset of COVID-19 to stroke was 8.0 ([4.1-11.9], p< 0.001, I(2)=93.1%). D-dimer was 3.3 μg/mL ([1.7-4.9], I(2)=86.3%), and cryptogenic stroke was most common as etiology at 50.7% ([31.0-70.4] I(2)=64.1%, 39/71patients). Case fatality rate was 44.2% ([27.9-60.5], I(2)=66.7%, 40/100 patients). CONCLUSIONS: This systematic review assessed the frequency and clinical characteristics of stroke in COVID-19 patients. The frequency of detected stroke in hospitalized COVID-19 patients was 1.1 % and associated with older age and stroke risk factors. Frequent cryptogenic stroke and elevated d-dimer level support increased risk of thromboembolism in COVID-19 associated with high mortality. Further study is needed to elucidate the pathophysiology and prognosis of stroke in COVID-19 to achieve most effective care for this population.


id: cord-297512-l9re9h4j
title: Interferon gamma (IFNγ) +874A/T gene polymorphism in South Indian ischemic stroke patients
author: Sultana, Shehnaz
date: 2011-07-17
txt: ./txt/cord-297512-l9re9h4j.txt
cache: ./cache/cord-297512-l9re9h4j.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/25205933/
doi: 10.5214/ans.0972.7531.1118305
summary:
  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.

abstract:
  BACKGROUND: Ischemic stroke is a complex vascular and metabolic process resulting in neuronal death and progression with time. Cytokines play a role in immune response and also maintains the normal homeostatic environment of the central nervous system. IFN-γ is one of the key effector cytokines produced by NK and T cells that enhances microbicidal activity of macrophages and neutrophils. PURPOSE: As the association of IFNγ +874A/T gene polymorphism with stroke has not been investigated in Indian population, we wanted to evaluate the association of this polymorphism with ischemic stroke in a South Indian population. METHODS: We genotyped 171 ischemic stroke patients and 153 age-matched control subjects. RESULTS: Statistical analysis showed a significant association of TT homozygote with ischemic stroke (OR=1.9, 95% CI=1.05-3.43, p=0.03), while AA (OR= 0.84, 95% CI=0.54–1.31, p=0.46) and AT(OR=0.80, 95% CI=0.51-1.26, p=0.34) genotypes were not significantly associated. A and T allele frequencies in stroke were 58.78% and 41.22% as against 65.36% and 34.64% in control group, respectively, thus, suggesting no statistically significant differences in the A (OR=0.75, 95% CI=0.54–1.03, p=0.08) and T (OR=1.32, 95% CI=0.96– 1.82, p=0.08) allele frequencies between the two groups. CONCLUSION: We conclude that the IFN-γ +874 TT genotype is associated with the increased risk of ischemic stroke.


id: cord-300742-hsfh4hw9
author: Ghoreishi, Abdoreza
date: 2020-09-16
txt: ./txt/cord-300742-hsfh4hw9.txt
cache: ./cache/cord-300742-hsfh4hw9.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1052305720307394?v=s5
doi: 10.1016/j.jstrokecerebrovasdis.2020.105321
summary:
  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).

title:
  Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran. From the CASCADE Initiative: statistical analysis plan and preliminary results

abstract:
  BACKGROUND: The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran. METHODS: This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. 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. We compared in-hospital mortality between study periods using Cox-regression model. RESULTS: During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE=0.24, P <0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS<5) ischemic stroke (P<0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; P=0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (P<0.0001). CONCLUSION: In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission rates for milder stroke may possibly be due to fear of exposure related to COVID-19. The decrease in patients treated with thrombolysis and the increased disability at discharge may indicate changes in the delivery of stroke care and increased pressure on existing stroke acute and subacute services. The results of this research will contribute to a similar analysis of the larger CASCADE dataset in order to confirm findings at a global scale and improve measures to ensure the best quality of care for stroke patients during the COVID-19 pandemic.


id: cord-302062-wqmynngg
title: Large artery ischemic stroke in severe COVID-19
author: Sierra-Hidalgo, Fernando
date: 2020-06-27
txt: ./txt/cord-302062-wqmynngg.txt
cache: ./cache/cord-302062-wqmynngg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32594301/
doi: 10.1007/s00415-020-09967-1
abstract: nan
summary:
  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.


id: cord-304636-houm2zcu
title: Unusual simultaneous cerebral infarcts in multiple arterial territories in a COVID-19 patient
author: Guillan, Marta
date: 2020-06-09
txt: ./txt/cord-304636-houm2zcu.txt
cache: ./cache/cord-304636-houm2zcu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.thromres.2020.06.015
doi: 10.1016/j.thromres.2020.06.015
summary:
  • 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] .

abstract:
  • 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). Acute ischaemic stroke continues to be a treatable medical emergency also during the SARS-CoV-2 pandemic. • Arterial thrombotic events may not only occur as a complication in severe cases of COVID-19; but can also appear in mild-moderate cases due to other mechanisms. • Several pathogeneses may be behind ischemic strokes in COVID-19, in addition to the more evident coagulopathy associated with the severe infection.


id: cord-307087-zsbmaieg
title: The Curious Case of the Missing Strokes During the COVID-19 Pandemic
author: Aguiar de Sousa, Diana
date: 2020-06-08
txt: ./txt/cord-307087-zsbmaieg.txt
cache: ./cache/cord-307087-zsbmaieg.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1161/strokeaha.120.030792
doi: 10.1161/strokeaha.120.030792
abstract: nan
summary:
  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.


id: cord-309227-kgrfnkns
author: Coote, Skye
date: 2020-10-09
txt: ./txt/cord-309227-kgrfnkns.txt
cache: ./cache/cord-309227-kgrfnkns.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1443950620314104
doi: 10.1016/j.hlc.2020.09.925
abstract: nan
summary:
  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

title:
  Letter to the Editor regarding: Critical considerations for stroke management during COVID-19 pandemic by Inglis et al., Heart Lung Circ. 2020;29(9): 1263–1267.


id: cord-309360-cpis1l4u
title: Ischaemic stroke and SARS-CoV-2 infection: A causal or incidental association?
author: Barrios-López, J. M.
date: 2020-05-28
txt: ./txt/cord-309360-cpis1l4u.txt
cache: ./cache/cord-309360-cpis1l4u.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S2173580820301012
doi: 10.1016/j.nrleng.2020.05.008
summary:
  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.

abstract:
  Abstract Introduction Ischaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection. Materials and methods We describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients. 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. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental. Conclusions Systemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.


id: cord-310105-a4fzp6bn
author: Kamdar, Hera A.
date: 2020-07-22
txt: ./txt/cord-310105-a4fzp6bn.txt
cache: ./cache/cord-310105-a4fzp6bn.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1052305720305978?v=s5
doi: 10.1016/j.jstrokecerebrovasdis.2020.105179
summary:
  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.

title:
  Clinician''s Perception of Practice Changes for Stroke During the COVID-19 Pandemic: Perception of Practice Changes for Stroke During COVID-19

abstract:
  BACKGROUND: Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey. METHODS: A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication. RESULTS: Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P=0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P=0.052, 95% CI: 0.988- 10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P=0.023, 95% CI: 1.110-4.132). 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. There is also a reported reduction in stroke volume across hospitals. 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.


id: cord-313539-fb5uzzua
title: Stroke in COVID-19 and SARS-CoV-1
author: Venketasubramanian, Narayanaswamy
date: 2020-05-26
txt: ./txt/cord-313539-fb5uzzua.txt
cache: ./cache/cord-313539-fb5uzzua.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1159/000508370
doi: 10.1159/000508370
abstract: nan
summary:
  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)


id: cord-315162-v3g6eios
author: De Silva, Deidre Anne
date: 2020-06-05
txt: ./txt/cord-315162-v3g6eios.txt
cache: ./cache/cord-315162-v3g6eios.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1052305720304274?v=s5
doi: 10.1016/j.jstrokecerebrovasdis.2020.105009
summary:
  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.

title:
  A protocol for acute stroke unit care during the COVID-19 pandemic: Acute stroke unit care during COVID-19

abstract:
  BACKGROUND: Acute stroke unit (ASU) care is proven to reduce mortality and morbidity. During the COVID-19 crisis, established physical units and care practices within existing physical units are likely to be disrupted. Stroke patients with possible suspected COVID-19 infection may be isolated in other wards outside the ASU. 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). CONCLUSIONS: Details are presented in the article in a format that it can be adopted by other centers facing similar issues in order to ensure ASU care is not compromised.


id: cord-321461-1s3y9kc5
title: Acute Ischemic and Hemorrhagic Stroke in COVID-19: Mounting Evidence
author: Rajdev, Kartikeya
date: 2020-08-31
txt: ./txt/cord-321461-1s3y9kc5.txt
cache: ./cache/cord-321461-1s3y9kc5.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10157
doi: 10.7759/cureus.10157
summary:
  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] .

abstract:
  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. In COVID-19 patients, the interaction of SARS-CoV-2 with these receptors in the cerebral blood vessels has been attributed to stroke. Although the incidence of acute ischemic stroke is relatively low, ranging from 1% to 6%, the mortality associated with it is substantially high, reaching as high as 38%. 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. The patients were diagnosed with acute stroke as a complication of COVID-19 infection. We also provide an insight into the possible mechanisms responsible for the life-threatening complication. Physicians should have a low threshold for suspecting stroke in COVID-19 patients, and close observation should be kept on such patients particularly those with clinical evidence of traditional risk factors.


id: cord-322628-sh09ij0f
author: Wong, Ka Sing
date: 2007-03-28
txt: ./txt/cord-322628-sh09ij0f.txt
cache: ./cache/cord-322628-sh09ij0f.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1474442207700790
doi: 10.1016/s1474-4422(07)70079-0
summary:
  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.

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

abstract:
  BACKGROUND: Acute stroke patients with large artery occlusive disease (LAOD) have a distinct pathophysiology and may respond differently to anticoagulation treatments. We compared the efficacy of a low-molecular-weight heparin (LMWH), nadroparin calcium, with aspirin in Asian acute stroke patients with LAOD. METHODS: Acute ischaemic stroke patients with onset of symptoms less than 48 h and LAOD (diagnosed by transcranial doppler imaging, carotid duplex scan, or magnetic resonance angiography) were recruited. Patients were randomly assigned to receive either subcutaneous nadroparin calcium 3800 anti-factor Xa IU/0·4 mL twice daily or oral aspirin 160 mg daily for 10 days, and then all received aspirin 80–300 mg once daily for 6 months. This study is registered at www.strokecenter.org/trials (number 493). FINDINGS: Among 603 patients recruited, 353 (180 LMWH, 173 aspirin) had LAOD (300 had intracranial LAOD only, 42 had both intracranial and extracranial disease, and 11 had extracranial disease only). The proportion of patients with good outcomes at 6 months (Barthel index ≥85) was 73% in the LMWH group and 69% in the aspirin group (absolute risk reduction 4%; 95% CI −5 to 13). Analysis of prespecified secondary outcome measures showed a benefit in outcome for LMWH versus aspirin on the modified Rankin scale dichotomised at 0–1 (odds ratio 1·55, 95% CI 1·02–2·35). Haemorrhagic transformation of infarct and severe adverse events were similar in both groups. Post-hoc analyses of patients without LAOD, and all treated patients, showed similar proportions with a good outcome in aspirin and LMWH groups (78% vs 79% and 73% vs 75%, respectively). INTERPRETATION: Overall, the results do not support a significant benefit of LMWH over aspirin in patients with LAOD. The benefits indicated in most outcome measures warrant further investigation into the use of anticoagulation for acute stroke in patients with large artery atherosclerosis, particularly in intracranial atherosclerosis.


id: cord-326626-ixxk6plf
author: Akhtar, Naveed
date: 2020-11-02
txt: ./txt/cord-326626-ixxk6plf.txt
cache: ./cache/cord-326626-ixxk6plf.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105435
doi: 10.1016/j.jstrokecerebrovasdis.2020.105435
summary:
  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.

title:
  Characteristics and Comparison of 32 COVID-19 and Non-COVID-19 Ischemic Strokes and historical stroke patients.

abstract:
  INTRODUCTION: : The presence of COVID-19 infection may increase the risk of thrombotic events including ischemic strokes. Whilst a number of recent reports suggest that COVID-19 associated stroke tends to be severe, there is limited data on the effects of COVID-19 in prospective registries. 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 Hamad General Hospital (HGH) stroke database was interrogated for stroke admissions during the last 4 months of 2019 and January-May 2020. RESULTS: : In Qatar the number of confirmed cases of COVID-19 increased from only 2 in February to 779 in March, 12,628 in April and 45,501 in May. Stroke admissions to HGH declined marginally from an average of 97/month for six pre-COVID months to 72/month in March – May. There were 32 strokes that were positive for COVID-19. When compared to non-COVID-19 stroke during the three months of the pandemic, COVID-19 patients were younger with significantly lower rates of hypertension, diabetes and dyslipidemia. COVID-19 positive patients had more cortical strokes (34.4% vs 5.6%; p= 0.001), severe disease (NIHSS >10: 34.4% vs 16.7%; p=0.001) prolonged hospitalization and fewer with good recovery (mRS 0-2: 28.1% vs 51.9%; p= 0.001). CONCLUSIONS: : When compared to six pre-COVID-19 months, the number of ischemic stroke admissions during the three months of the pandemic declined marginally. COVID-19 positive patients were more likely to have a large cortical stroke with severe symptoms and poor outcome.


id: cord-327511-e3idvknz
title: Characteristics of a Diverse Cohort of Stroke Patients with SARS-CoV-2 and Outcome by Sex
author: Trifan, G.
date: 2020-09-11
txt: ./txt/cord-327511-e3idvknz.txt
cache: ./cache/cord-327511-e3idvknz.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S1052305720307321
doi: 10.1016/j.jstrokecerebrovasdis.2020.105314
summary:
  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.

abstract:
  BACKGROUND AND PURPOSE: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. To objective of this paper is to describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex on outcome. METHODS: This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage or median and interquartile range. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. RESULTS: The study included 83 patients, 47% of which were Black, 28% Hispanics/Latinos, and 16% whites. Median age was 64 years. Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p=0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared with females, males had higher mortality (38% vs. 13%; p=0.02) and were less likely to be discharged home (12% vs. 33%; p=0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR=1.47, 95% CI=1.03-2.09). 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.


id: cord-330137-7w7wqy4h
author: Borhani-Haghighi, Afshin
date: 2020-07-15
txt: ./txt/cord-330137-7w7wqy4h.txt
cache: ./cache/cord-330137-7w7wqy4h.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1159/000508608
doi: 10.1159/000508608
abstract: nan
summary:
  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.

title:
  Time Is Brain: A Call to Action to Support Stroke Centers in Low- and Middle-Income Countries during the COVID-19 Pandemic


id: cord-332065-afq26621
title: Racial Disparity Amongst Stroke Patients During the Coronavirus Disease 2019 Pandemic
author: Ghanchi, Hammad
date: 2020-09-10
txt: ./txt/cord-332065-afq26621.txt
cache: ./cache/cord-332065-afq26621.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10369
doi: 10.7759/cureus.10369
summary:
  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.

abstract:
  Introduction The global coronavirus disease 2019 (COVID-19) pandemic has had deleterious effects on our healthcare system. Lockdown measures have decreased the number of patients presenting to the hospital for non-respiratory illnesses, such as strokes. Moreover, there appears to be a racial disparity among those afflicted with the virus. We sought to assess whether this disparity also existed for patients presenting with strokes. Methods The Get with the Guidelines National Stroke Database was reviewed to assess patients presenting with a final diagnosis of ischemic stroke, transient ischemic attack (TIA), subarachnoid hemorrhage (SAH), or spontaneous/nontraumatic intraparenchymal hemorrhage (IPH). The period of February - May 2020 was chosen given the surge of patients affected with the virus and national shutdowns. Data from this same time during 2019 was used as the control population. Our hospital numbers and four additional regions were assessed (California hospitals, Pacific State hospitals, Western Region hospitals, and all hospitals in the United States). Patients were categorized by race (White, Black/African American, Asian, Native American, Hispanic) in each cohort. 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). Results A downward trend in total number of patients was noted in all five regional cohorts assessed. 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. A statistically significant increase in the Hispanic population was noted in February and March in all California hospitals (p=0.005 and 0.02, respectively) and Pacific Coast hospitals (p=0.005 and 0.039, respectively). The Western region and all national hospitals noted a significant increase in strokes in the Hispanic population in April (p=0.039 and 0.023, respectively). A statistically significant increase of strokes in the Black population was noted in April in Pacific hospitals, Western region hospitals, and all national hospitals (p=0.039, 0.03, and 0.03, respectively). Conclusion The COVID-19 pandemic has adversely affected certain racial groups more than others. A similar increase is noted in patients presenting with strokes in these specific racial populations. Moreover, lack of testing for the SARS-CoV-2 virus may be missing a possible link between racial disparity for patients infected with the virus and patients presenting with stroke. The authors advocate for widespread testing for all patients to further assess this correlation.


id: cord-334482-fpxd0ont
title: COVID-19 related stroke in young individuals
author: Fifi, Johanna T
date: 2020-08-18
txt: ./txt/cord-334482-fpxd0ont.txt
cache: ./cache/cord-334482-fpxd0ont.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1474442220302726
doi: 10.1016/s1474-4422(20)30272-6
abstract: nan
summary:
  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.


id: cord-338628-7l9b5mqp
author: Nguyen-Huynh, Mai N.
date: 2020-08-17
txt: ./txt/cord-338628-7l9b5mqp.txt
cache: ./cache/cord-338628-7l9b5mqp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1161/strokeaha.120.031099
doi: 10.1161/strokeaha.120.031099
summary:
  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).

title:
  Acute Stroke Presentation, Care, and Outcomes in Community Hospitals in Northern California During the COVID-19 Pandemic

abstract:
  Shelter-in-place (SIP) orders implemented to mitigate severe acute respiratory syndrome coronavirus 2 spread may inadvertently discourage patient care-seeking behavior for critical conditions like acute ischemic stroke. We aimed to compare temporal trends in volume of acute stroke alerts, patient characteristics, telestroke care, and short-term outcomes pre- and post-SIP orders. METHODS: We conducted a cohort study in 21 stroke centers of an integrated healthcare system serving 4.4+ million members across Northern California. We included adult patients who presented with suspected acute stroke and were evaluated by telestroke between January 1, 2019, and May 9, 2020. SIP orders announced the week of March 15, 2020, created pre (January 1, 2019, to March 14, 2020) and post (March 15, 2020, to May 9, 2020) cohort for comparison. Main outcomes were stroke alert volumes and inpatient mortality for stroke. RESULTS: Stroke alert weekly volume post-SIP (mean, 98 [95% CI, 92–104]) decreased significantly compared with pre-SIP (mean, 132 [95% CI, 130–136]; P<0.001). Stroke discharges also dropped, in concordance with acute stroke alerts decrease. In total, 9120 patients were included: 8337 in pre- and 783 in post-SIP cohorts. There were no differences in patient demographics. Compared with pre-SIP, post-SIP patients had higher National Institutes of Health Stroke Scale scores (P=0.003), lower comorbidity score (P<0.001), and arrived more often by ambulance (P<0.001). Post-SIP, more patients had large vessel occlusions (P=0.03), and there were fewer stroke mimics (P=0.001). Discharge outcomes were similar for post-SIP and pre-SIP cohorts. CONCLUSIONS: In this cohort study, regional stroke alert and ischemic stroke discharge volumes decreased significantly in the early COVID-19 pandemic. Compared with pre-SIP, the post-SIP population showed no significant demographic differences but had lower comorbidity scores, more severe strokes, and more large vessel occlusions. The inpatient mortality was similar in both cohorts. Further studies are needed to understand the causes and implications of care avoidance to patients and healthcare systems.


id: cord-345437-j3akzx10
title: What has caused the fall in stroke admissions during the COVID-19 pandemic?
author: Perry, Richard
date: 2020-06-29
txt: ./txt/cord-345437-j3akzx10.txt
cache: ./cache/cord-345437-j3akzx10.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32601757/
doi: 10.1007/s00415-020-10030-2
abstract: nan
summary:
  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).


id: cord-353824-0oyvia6d
title: Coronavirus Disease 2019-Related Acute Ischemic Stroke: A Case Report
author: Farooque, Umar
date: 2020-09-08
txt: ./txt/cord-353824-0oyvia6d.txt
cache: ./cache/cord-353824-0oyvia6d.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10310
doi: 10.7759/cureus.10310
summary:
  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

abstract:
  Coronavirus disease 2019 (COVID-19) is an active worldwide pandemic with diverse presentations and complications. Most patients present with constitutional and respiratory symptoms. Acute ischemic stroke remains a medical emergency even during the COVID-19 pandemic. 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. On examination, the patient had a score of 8/15 on the Glasgow coma scale (GCS). There was a right-sided sensory loss and weakness in both upper and lower limbs with a positive Babinski's sign. The pulmonary examination was remarkable for bilateral crepitation. On blood workup, there was leukocytosis and raised c-reactive protein (CRP). D-dimer, ferritin, thyroid-stimulating hormone (TSH), vitamin B12, and hypercoagulability workup were normal. Transthoracic echocardiography was also normal. COVID-19 polymerase chain reaction (PCR) detected the virus. Chest x-ray showed infiltrations in the left middle and both lower zones of the lungs in the peripheral distribution. Computed tomography (CT) scan of the chest showed peripheral and mid to basal predominant multilobar ground-glass opacities. CT scan of the head showed a large hypodense area, with a loss of gray and white matter differentiation, in the left middle cerebral artery territory. Magnetic resonance imaging (MRI) of the head showed abnormal signal intensity area in the left parietal region. It appeared isointense on T1 image and hyperintense on T2 image. It also showed diffusion restriction on the diffusion-weighted 1 (DW1) image with corresponding low signals on the apparent diffusion coefficient (ADC) map. These findings were consistent with left middle cerebral artery territory infarct due to COVID-19. The patient was intubated in the ED. He was deemed unfit for thrombolysis and started on aspirin, anti-coagulation, and other supportive measures. Patients with COVID-19 should be evaluated early for neurological signs. Timely workup and interventions should be performed in any patient suspected of having a stroke to reduce morbidity and mortality.


id: cord-354866-5yzalrri
title: The effect of COVID-19 on stroke hospitalizations in New York City
author: Esenwa, Charles
date: 2020-07-13
txt: ./txt/cord-354866-5yzalrri.txt
cache: ./cache/cord-354866-5yzalrri.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105114
doi: 10.1016/j.jstrokecerebrovasdis.2020.105114
summary:
  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.

abstract:
  BACKGROUND: Little is known about the effect of the Coronavirus disease 2019 pandemic on stroke care and the impact of the epidemic on acute stroke hospitalizations has not been described. METHODS: We analyze the stroke admission rate in three hospitals in New York City from January 1, 2020 through April 17, 2020, identifying all cases of acute ischemic stroke, intraparenchymal hemorrhage and subarachnoid hemorrhage. RESULTS: We confirmed 518 cases of out-of-hospital stroke. 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 pandemic period, the slope was -4.4 (se = 1.00); i.e., the number of stroke admissions decreased an average of 4.4 per week, (p = 0.005), with weekly admissions averaging 23, a reduction of 44% versus baseline. This general result was not different by patient age, sex, or race/ethnicity. CONCLUSIONS: The weekly stroke admission rate started declining two weeks prior to the local surge of coronavirus admissions. The consequences of lack of diagnosis and treatment of a large proportion of acute stroke patients are likely severe and lasting.


id: cord-355481-1avavlu3
title: “Changes in Stroke Presentation in Neo-Covid Patients: A Case Study”
author: Anoop, Kohli
date: 2020-10-02
txt: ./txt/cord-355481-1avavlu3.txt
cache: ./cache/cord-355481-1avavlu3.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S2214751920305107?v=s5
doi: 10.1016/j.inat.2020.100949
summary:
  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.

abstract:
  A 35 year old male had a generalized seizure a week after symptoms of daily fever, rigors, and throat discomfort. He was hospitalized. Magnetic resonance imaging brain showed multiple bilateral scattered infarcts. COVID-19 swab test came positive. An elaborate panel of tests for young strokes, cardiac work-up was normal. At home, he complained of some visual blurring, slowing in thought processing, occasional loss of words. His face became significantly pigmented. A young male, COVID-19 positive, showed multiple scattered infarcts. Exaggerated pro-thrombotic activity of the nature of a cytokine storm, is the probable cause.


