Objective:The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods.Methods:We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases.Results:There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI, -11.7 to - 11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI, -13.8 to -12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI, -13.7 to -10.3, p=0.001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions.Conclusions:The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

BackgroundAcute stroke care is complex and requires multidisciplinary networking. There are insufficient data on stroke care in the Middle East and adjacent regions in Asia and Africa.ObjectiveEvaluate the state of readiness of stroke programs in the Middle East North Africa and surrounding regions (MENA+) to treat acute stroke.MethodOnline questionnaire survey on the evaluation of stroke care across hospitals of MENA+ region between April 2021 and January 2022.ResultsThe survey was completed by 34/50 (68%) hospitals. The median population serviced by participating hospitals was 2 million. The median admission of patients with stroke/year was 600 (250–1,100). The median length of stay at the stroke units was 5 days. 34/34 (100%) of these hospitals have 24/7 CT head available. 17/34 (50%) have emergency guidelines for prehospital acute stroke care. Mechanical thrombectomy with/without IVT was available in 24/34 (70.6%). 51% was the median (IQR; 15–75%) of patients treated with IVT within 60 min from arrival. Thirty-five minutes were the median time to reverse warfarin-associated ICH.ConclusionThis is the first large study on the availability of resources for the management of acute stroke in the MENA+ region. We noted the disparity in stroke care between high-income and low-income countries. Concerted efforts are required to improve stroke care in low-income countries. Accreditation of stroke programs in the region will be helpful.

ABSTRAK

Background: Transverse sinus stenosis (TSS) is a common finding on MRI of patients with refractory chronic headaches. Bilateral TSS with severity >50% was found in almost all (93%) patients with idiopathic intracranial hypertension (IIH). IIH can lead to papilledema and result in loss of visual function. This study aimed to determine the prevalence of TSS in patients with refractory chronic headache at Pelni hospital, Jakarta.Methods: This was a descriptive analytical study and conducted at Pelni hospital, Jakarta from January to June 2021, with a sample of patients suffering from refractory chronic headaches. Data were analyzed using SPSS version 24.Results: There were 70 subjects, with a mean age of 52.97±13.29, the majority aged <60 years (65.7%), with the male sex being more dominant (62.9%). There were 39 people (55.7%) with TSS; as many as 37 with (52.9%) left TSS and 2 (2.8%) with right TSS. Bivariate analysis with Chi square showed no relationship between age and sex with the presence of TSS in patients with refractory chronic headache (p=0.798 and p=0.487).Conclusions: TSS was associated with the incidence of IIH. However, this finding has not yet been proven to be significant. This study also did not find a correlation between age and gender with the incidence of TSS.

CEREBRAL SINUS VENOSUS STENTING IN IDIOPATHIC INTRACRANIAL HYPERTENSIONABSTRACTIdiopathic intracranial hypertension (IIH) is a group of symptoms caused by increase in intracranial pressure without any damage of brain parenchyma. Idiopathic intracranial hypertension is usually known as cerebral pseudotumor. This disease can cause visual disturbance, even visual loss, thus decrease quality of daily living. Treatment of this disease consists of disease modifying, medicine, surgery and neurovascular interventional procedure such as venous sinus stenting. High risk in failure and complication of surgery gives venous sinus stent procedure a chance to grow. Case reports and meta-analysis showed that venous sinus stent has high success rate and very low complication rate.Keywords: Cerebral pseudotumor, intracranial idiopathic hypertension (IIH), venous sinus stent (VSS)ABSTRAKHipertensi  intrakranial  idiopatik  (HII)  merupakan  kumpulan  gejala  akibat  peningkatan  tekanan  intrakranial tanpa dijumpai adanya kelainan pada parenkim otak. HII sering dikenal dengan pseudotumor serebri. Penyakit ini dapat menimbulkan penurunan kualitas hidup sehari-hari dengan timbulnya penurunan tajam penglihatan bahkan memiliki potensi kebutaan. Tata laksana HII terdiri dari medikamentosa, operatif dan prosedur neurovaskular intervensi berupa prosedur stent sinus venosus. Risiko kegagalan dan angka komplikasi yang tinggi pada tindakan operatif memberikan kesempatan pada prosedur stent sinus venosus untuk berkembang. Laporan kasus, penelitian dan uji meta analisa memberikan kesimpulan bahwa prosedur stent sinus venosus memberikan angka keberhasilan yang tinggi dan angka komplikasi yang sangat rendah.Kata kunci: Hipertensi intrakranial idiopatik (HII), pseudotumor serebri, stent sinus venosus