Ischemic stroke rates decrease during COVID-19 pandemic
June 9, 2020
Science Daily/Michigan Medicine - University of Michigan
A new research letter reveals fewer people have been admitted to stroke centers in Michigan and northwest Ohio since the onslaught of the COVID-19 pandemic, and significantly fewer patients received a mechanical thrombectomy for their ischemic stroke.
The authors call COVID-19's influence on other critical illnesses like stroke a bystander effect. That's because time is of the essence for patients with stroke, but not everyone is getting to a comprehensive stroke center for needed care right now.
In the letter, researchers from Michigan Medicine with colleagues across the Michigan Stroke Treatment Improvement Collaborative reported a significant reduction in ischemic stroke admissions in March when compared both to February of this year (17.8%) and to March of 2019 . Similarly, rates of a procedure for ischemic stroke, mechanical thrombectomy, significantly declined this March compared to February and compared to March of 2019.
"A combination of patient fears, stringent patient transfer criteria, and health system strains may have contributed to lower ischemic stroke admissions as well as the near disappearance of thrombectomy procedures," the authors write.
The differences were most pointed in ischemic stroke and quantity of thrombectomy procedures, authors say, while there was less of a change compared to past months for hemorrhagic stroke.
https://www.sciencedaily.com/releases/2020/06/200609095025.htm
Coronavirus linked to stroke in otherwise healthy young people
June 4, 2020
Science Daily/Thomas Jefferson University
Young patients with no risk factors for stroke may have an increased risk if they have contracted COVID-19, whether or not they are showing symptoms of the disease. Surgeons at Thomas Jefferson University and collaborators analyzed patients presenting with stroke from March 20th until April 10th at their institutions. The strokes they observed were unlike what they usually see.
"We were seeing patients in their 30s, 40s and 50s with massive strokes, the kind that we typically see in patients in their 70s and 80s," says Pascal Jabbour, MD, Chief of the Division of Neurovascular Surgery and Endovascular Surgery in the Vickie & Jack Farber Institute for Neuroscience -- Jefferson Health. He is a senior author of a study published in the journal Neurosurgery June 4th, that examines and characterizes strokes of patients who tested positive for COVID-19, done in collaboration with surgeons from NYU Langone Medical Center in New York.
"Although we have to stress that our observations are preliminary, and based on observations from 14 patients, what we have observed is worrying," says Dr. Jabbour. "Young people, who may not know they have the coronavirus, are developing clots that cause major stroke."
The researchers, including first author Ahmad Sweid, MD, examined 14 patients who had come into their Neurointerventional room for stroke. Eight patients were male, six were female, 50%, did not know they had the coronavirus, while the remainder were already being treated for other symptoms of the disease when they developed stroke.
Some of the paper's major points:
Patients with signs of stroke were delaying coming to the hospital for fear of getting the coronavirus. There's a small window of time in which strokes are treatable, so delays can be life threatening.
The mortality rate in these covid-19 stroke patients is 42.8%. The typical mortality from stroke is around 5 to 10%.
42% of the stroke coronavirus positive patients studied were under the age of 50. Most strokes, over 75% of all strokes in the US, occur in people over the age of 65.
The incidence of coronavirus in the stroke population was 31.5%, according to this sample of patients.
Patients observed had stroke in large vessels, in both hemispheres of the brain, and in both arteries and veins of the brain -- all of these observations are unusual in stroke patients.
Why is the coronavirus, which was assumed to be a disease of the lungs, causing blood clots that lead to a higher incidence of stroke? Researchers have shown that the coronavirus enters human cells via a very specific access point -- a protein on human cells called ACE2. But the coronavirus latches onto this protein and uses it to as a gateway into the cell, where the virus can replicate. Not all cells have the same amount of ACE2. This protein is very abundant on cells that line blood vessels, the heart, kidney, and of course, the lungs. Dr. Jabbour and colleagues speculate that the virus may be interfering with this receptor's normal function, which controls blood flow in the brain, in addition to using it as an entry point to the cell.
Another possibility is that the inflammation of the blood vessels causing vasculitis with injury to the cells lining the lumen of the vessel, called endothelium and causing micro thrombosis in small vessels.
"Our observations, though preliminary, can serve as a warning for medical personnel on the front lines, and for all of those at home," says Dr. Jabbour. "Stroke is occurring in people who don't know they have COVID-19, as well as those who feel sick from their infections. We need to be vigilant and respond q uickly to signs of stroke."
https://www.sciencedaily.com/releases/2020/06/200604095600.htm
Clues to COVID-19 in the brain uncovered
Researchers review neuroimaging for patients and show altered mental state and stroke dominate
May 27, 2020
Science Daily/University of Cincinnati
A study by University of Cincinnati researchers and four Italian institutions reviewing neuroimaging and neurological symptoms in patients with COVID-19 may shed light on the virus's impact on the central nervous system.
The findings, published in the journal Radiology, reveal that altered mental status and stroke are the most common neurological symptoms in COVID-19 patients, which authors say could help physicians notice "red flags" earlier.
"Studies have described the spectrum of chest imaging features of COVID-19, but only a few case reports have described COVID-19 associated neuroimaging findings," says lead author Abdelkader Mahammedi, MD, assistant professor of radiology at UC and a UC Health neuroradiologist. "To date, this is the largest and first study in literature that characterizes the neurological symptoms and neuroimaging features in COVID-19 patients. These newly discovered patterns could help doctors better and sooner recognize associations with COVID-19 and possibly provide earlier interventions."
Researchers in this study investigated neurological symptoms and imaging findings in patients from three major institutions in Italy: University of Brescia, Brescia; University of Eastern Piedmont, Novara; and University of Sassari, Sassari. Italy was the second epicenter of the spread of COVID-19, resulting in over 30,000 deaths.
The study included images from 725 hospitalized patients with confirmed COVID-19 infection between Feb. 29 and April 4. Of these, 108 (15%) had serious neurological symptoms and underwent brain or spine imaging. Most patients (99%) had brain CT scans, while 16% had head and neck CT imaging and 18% had brain MRI.
Investigators found that 59% of patients reported an altered mental state and 31% experienced stroke, which were the most common neurological symptoms. Patients also experienced headache (12%), seizure (9%) and dizziness (4%), among other symptoms.
"Of these 108 patients, 31, or 29%, had no known past medical history. Of these, aged 16 to 62 years, 10 experienced stroke and two had brain bleeds," Mahammedi says. "Seventy-one, or 66%, of these patients had no findings on a brain CT, out of which 7 of them (35%) brain MRI showed abnormalities."
He adds that altered mental status was more common in older adults.
While results show that the neuroimaging features of patients with COVID-19 vary, and an altered mental status and stroke are the most prevalent in patients, Mahammedi says this study reveals that there are other conditions to be on the lookout for.
"This topic definitely needs more research," he says. "Currently, we have a poor understanding of the neurological symptoms in COVID-19 patients, whether these are arising from critical illness or from direct central nervous system invasion of SARS-CoV-2. We hope further study on this subject will help in uncovering clues and providing better interventions for patients."
https://www.sciencedaily.com/releases/2020/05/200527105049.htm