key: cord-0868371-hdne7pcs
authors: Qureshi, Adnan I.; Abd-Allah, Foad; Alsenani, Fahmi; Aytac, Emrah; Borhani-Haghighi, Afshin; Ciccone, Alfonso; Gomez, Camilo R.; Gurkas, Erdem; Hsu, Chung Y.; Jani, Vishal; Jiao, Liqun; Kobayashi, Adam; Lee, Jun; Liaqat, Jahanzeb; Mazighi, Mikael; Parthasarathy, Rajsrinivas; Shahmiran, Muhammad; Steiner, Thorsten; Toyoda, Kazunori; Ribo, Marc; Gongora-Rivera, Fernando; Oliveira-Filho, Jamary; Uzun, Guven; Wang, Yongjun
title: Management of acute ischemic stroke in patients with COVID-19 infection: Insights from an international panel
date: 2020-05-11
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.05.018
sha: 962c48817eb8e25905e4cb7e1e13f7b6dd6d65ec
doc_id: 868371
cord_uid: hdne7pcs

nan

J o u r n a l P r e -p r o o f A corona virus (SARS-CoV-2) has infected 986,776 persons as of April 2nd, 2020 over a period of 4 months. There is a possibility that Coronavirus Disease 2019 (COVID-19) infection increases the risk of stroke similar to other respiratory tract infections 1 . Approximately 5% of hospitalized patients with COVID-19 infection suffer from stroke with over 80% of them being ischemic stroke 2 . The reported mortality is 39% in patient with stroke 2 and COVID-19 infection which is much higher than the mortality observed in patients with stroke without COVID-19 infection 3. Medical professionals involved in evaluation and management of acute stroke patients are at risk of acquiring COVID-19 infection from suspected or confirmed COVID-19 infected patients or those who are asymptomatic carriers or in the prodromal period, or in whom neurological deficits is the first manifestation. The magnitude of risk of COVID-19 infection transmission during acute stroke patient management is not known. The time frame required to confirm the infection based on upper respiratory specimen using reverse-transcription polymerase chain reaction test and at times need for repeat testing does not allow the information to be available to stroke team members at time of decision making. Members of stroke team must use basic principles targeting prevention of disease transmission including maintaining a 1-meter distance from patient (unless absolutely necessary) and use a combination of use of surgical mask gloves, gowns, goggles or face shield and handwashing. Whether a particulate filtering facepiece respirator such as N95 (United States), FFP2 (Europe), KN95 (China), P2 (Australia/New Zealand), K94 (Korea KMOEL), or DS (Japan) is necessity is not clear as stroke evaluation does not involve aerosol generating procedures 4 . However, such use may be regulated by country and institution specific standards and also depend upon availability and regional COVID-19 infection Prospective registries may help understand whether there are differences in stroke risk, manifestations, response to treatment strategies, and outcomes in patients with COVID-19 infection.

References:

Risk of myocardial infarction and stroke after acute infection or vaccination

Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study

Trends in in-hospital mortality among patients with stroke in China

Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial

Effects of Telestroke on Thrombolysis Times and Outcomes: A Meta-analysis

High Plasma D-Dimer Indicates Unfavorable Outcome of Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis