The emergence and spread of the highly contagious novel coronavirus disease (COVID-19) have triggered the greatest public health challenge of the last century. Aside from being a primary respiratory disease, acute ischemic stroke has emerged as a complication of the disease. While current evidence shows COVID-19 could cause ischemic stroke especially in severe disease, there are similarities in the risk factors for severe COVID-19 as well as ischemic stroke, underscoring the complex relationship between these two conditions. The pandemic has created challenges for acute stroke care. Rapid assessment and time-sensitive interventions required for optimum outcomes in acute stroke care have been complicated by COVID-19 due to the need for disease transmission preventive measures. The purpose of this article is to explore the putative mechanisms of ischemic stroke in COVID-19 and the clinical characteristics of COVID-19 patients who develop ischemic stroke. In addition, we discuss the challenges of managing acute ischemic stroke in the setting of COVID-19 and review current management guidelines. We also highlighted potential areas for future research.

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Sleep is an important physiological function that contributes significantly to the health and well-being of people worldwide. In Nigeria, the most populous country in Africa, sleep problems have been reported across various age groups from childhood to the elderly population. It is therefore noteworthy to access and report the state of sleep medicine practice in Nigeria as well as the strengths, weaknesses, opportunities, and threats to the establishment of a successful sleep medicine program in the country. Sleep problems appear to be on the rise in the Nigerian population. This may be due to an increase in the prevalence of some risk factors for sleep disorders. It can also be attributed to the growing interest in sleep research and clinical sleep medicine practice by a wide range of specialists. However, the practice of sleep medicine in Nigeria appears to be significantly limited by the poor manpower development, lack of sleep societies/organizations, lack of training programs, lack of equipment and sleep laboratories, limited treatment options, inadequate funding, poor national awareness, and political will. The increasing political unrest and brain drain of health professionals constitute a major threat to the availability of human resources. The practice of sleep medicine in Nigeria is faced with challenges as well as diverse opportunities. Thus, sleep medicine practice in Nigeria has the potential to grow rapidly and contribute significantly to the global picture if given attention. The growing interest of Nigerian researchers in Sleep medicine, especially in the last decade, as well as the large population of Nigerians, many of whom have risk factors for sleep disorders, suggest that Nigeria may be a significant contributor to the global burden of sleep disorders. Therefore, we suggest concerted and coordinated efforts to enhance the strengths and opportunities highlighted while minimising or eliminating the challenges to improve the practice of sleep medicine in Nigeria.

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An acute ischemic stroke, though carrying the risk of debilitating complications, is a preventable and treatable disease. Thrombolysis and endovascular thrombectomy are important components of its management. However, various challenges in resource-poor countries like Nigeria and other developing nations pose a great limitation in the timely intervention of ischemic stroke treatment. The challenges include late presentation, poor awareness of stroke symptoms even among health care workers, poor ambulance service/transportation network, intra-hospital delay, particularly in neuroimaging, and the unavailability of tissue plasminogen activator (alteplase/tenecteplase). We report a 32-year-old African man with an antecedent history of suspected migraine headaches with aura and a family history of hypertension and stroke, admitted 7½ hours after onset of stroke symptoms, scoring 13 on the National Institutes of Health Stroke Scale (NIHSS) with Medical Research Council (MRC) muscle power grades 1 and 3 on the right upper and lower extremities, respectively. Urgent non-contrast brain CT revealed only a hyperdense sign in the left middle cerebral artery (MCA). Intravenous tissue plasminogen activator (tPA) was administered at a lower dose of 0.6 mg/kg, 15½ hours after symptom onset, and a CT angiogram done 24 hours post-thrombolysis showed partial recanalization of the M1 segment of the MCA and intermediate collateral supply (Alberta stroke program early CT {ASPECT} score: 6). By the third day of admission, he had made a significant clinical improvement and was discharged home able to walk unsupported on the fourth day.

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