Objective To describe the difference in clinical presentation, including race, of ischemic stroke between patients with and without novel coronavirus disease 2019 (COVID-19), and the association of inflammatory response with stroke severity. Methods This is a retrospective, observational, cross-sectional study of patients (n = 60) admitted with ischemic stroke between late March and early May 2020. All patients were tested for COVID-19 during admission. Demographic, clinical, and laboratory data was collected through electronic medical record review. Descriptive statistics was performed to observe the differences between stroke patients with and without COVID-19 Results 60 hospitalized patients with acute ischemic stroke were included in the analysis. Nine were positive for COVID-19. African-Americans comprised of 55.6% of those that had COVID-19 and stroke and 37.7% of those with only stroke. Stroke patients with COVID-19 had a significantly higher NIHSS [18.4 (8.8)] and neutrophil-to-lymphocyte ratio (NLR) [7.3 (4.2) vs 3.8 (2.8); P = 0.0137] than those without. Those with COVID-19 also had a significantly higher mortality rate (44.4% vs. 7.6%; p < 0.001). Conclusion We observed a cohort of patients, including a large proportion of African-Americans, who developed ischemic stroke with or without COVID-19. An exaggerated inflammatory response, as indicated by NLR, likely plays a role in stroke severity among COVID-19 patients that concurrently develop ischemic stroke.
Objective: Intracerebral hemorrhage can lead to significant long-term disability. While research in stroke rehabilitation has focused primarily on ischemic strokes, identifying factors that impact recovery in patients with intracerebral hemorrhage is necessary. Our purpose is to identify factors, including racial and sex disparities, associated with functional outcomes in intracerebral hemorrhage patients after inpatient rehabilitation. Design: This was a retrospective analysis of consecutive patients with intracerebral hemorrhage admitted to an inpatient rehabilitation facility at an academic tertiary facility in the Southeastern United States from 2016 to 2019. Clinical characteristics, demographics, admission, and discharge Functional Independence Measure scores were collected. Results: We evaluated 59 patients (54.4 ± 14.1 yrs, 39% females, 48.2% African American) with a median intracerebral hemorrhage volume of 13.4 (4.2-33.0) and a mean (SD) Functional Independence Measure efficiency of 1.8 ± 1.3. In multiple regression, being female was negatively associated with Functional Independence Measure efficiency (β = −1.13, P = 0.0037) when adjusting for race and intracerebral hemorrhage score. The Functional Independence Measure efficiency was lower in African Americans (β = −0.97, P = 0.0119) when adjusting for sex and intracerebral hemorrhage volume. Conclusions:The results of our study indicate that Functional Independence Measure efficiency was worse for African Americans and female patients with intracerebral hemorrhage. Future research should consider these racial and sex disparities and focus on providing targeted rehabilitation therapy.
The objective of the present study was to systematically review the existing literature for studies examining the association between posttraumatic stress disorder (PTSD) and stroke risk and perform a meta‐analysis to obtain a pooled risk estimate describing the association. A literature search was conducted in PubMed, Embase, PSYCInfo, and CINAHL to identify relevant studies. Cohort and cross‐sectional studies that reported PTSD exposure (i.e., PTSD diagnosis, probable PTSD, or the presence of PTSD symptoms) at baseline and the risk or odds of stroke associated with PTSD exposure during the study period were included in the analysis. A random‐effects model was used to calculate the pooled hazard ratio (HR) for cohort studies estimating the association between PTSD and stroke. Overall, 11 studies met the inclusion criteria; eight were cohort studies, and three were cross‐sectional studies. Two cohort studies and all cross‐sectional studies used self‐report of PTSD symptoms to measure the exposure. The pooled hazard ratio for the eight cohort studies showed that having PTSD was associated with a 59% higher risk of incident stroke, HR = 1.59, 95% CI [1.36, 1.86], I2 = 81%. The association remained statistically significant in a subgroup analysis of six United States–based studies, HR = 1.38; 95% CI [1.29, 1.49], I2 = 18%. The findings suggest that PTSD is associated with an increased risk of stroke. More studies are required to explore a causal association between PTSD and stroke.
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