Novel coronavirus SARS-CoV-2 has created unprecedented healthcare challenges. Neurologic deficits are often an important presenting symptom. To date, the only reported post-infectious COVID-19 manifestations of neurologic disease include cognitive deficits and dysfunction of the peripheral nervous system. Here we report that seizure can also be a post-COVID-19 or “long-COVID” complication. We present a 71-year-old man with hypertension, diabetes mellitus, and COVID-19 diagnosed by RT-PCR who initially presented with posterior circulation stroke-like symptoms, which completely resolved after emergent thrombolysis. Six days later, the patient returned with seizure activity, supported by radiographic and electroencephalographic studies. Notably, he was negative for SARS-CoV-2, and no other provoking factor was uncovered after a comprehensive work-up. To our knowledge, this is the first report of post-infectious seizures after a case of COVID-19, highlighting the potential importance of monitoring for neurologic symptoms in COVID-19 patients, even after convalescence.
Hypercoagulability and virally-mediated vascular inflammation have become well-recognized features of the SARS-CoV-2 virus infection, COVID-19. Of growing concern is the apparent ineffectiveness of therapeutic anticoagulation in preventing thromboembolic events among at-risk patient subtypes with COVID-19. We present a 43-year-old female with a history of seropositive-antiphospholipid syndrome and systemic lupus erythematosus who developed an acute ischemic stroke in the setting of mild COVID-19 infection despite adherence to chronic systemic anticoagulation. The clinical significance of SARS-CoV-2-mediated endothelial cell dysfunction and its propensity for producing macrovascular events in the absence of coagulopathy warrants further investigation and likely represents the disease-defining pathology of COVID-19.
Introduction:
Scholarly activity is important to achieving academic and clinical proficiency during residency and fellowship and an ACGME requirement. Team science is known to propel research productivity, but we found few programs within neurology using team science to promote scholarly productivity. Also, studies report that women are often under-represented as first or co-authors within publications. CREST is a team-science initiative developed and implemented in 2018 that is based on research-supported determinants shown to improve scholarly activity and involvement among trainees within vascular neurology. Here we assessed whether implementing the CREST Initiative improved involvement in scholarly activity amongst neurology residents and fellows in the field of vascular neurology by assessing the number of publications residents and fellows co-authored within the field of vascular neurology and the representation of women as first or co-authors of those publications following the introduction of CREST.
Methods:
This study used PubMed as a search engine for publications. Articles were included in data analysis if published between 2015-2021 by a Vascular Neurology faculty member, and authorship included at least one neurology resident or stroke fellow. Linear regression with Graph Pad was used for statistical analysis.
Results:
From 2015 to 2022, the number of stroke publications per academic year, including residents or fellows as authors or co-authors, increased from 0 per year to 9 per year, which linear regression demonstrated was a significant increase (βo 2.726, [Confidence Interval 2.130 - 3.283], R2 0.8854). Similarly, linear regression demonstrated that the number of women included as co-authors or first authors in publications increased from 0 in 2015 to 5 in 2022(βo 18.30, [Confidence Interval 15.56 - 21.04], R2 0.9722). Inpatient clinical service weeks did not change significantly over time (p-value 0.9485).
Conclusion:
Results of this study highlight the significance of initiatives geared toward career development and research in successfully promoting scholarly activity in post-graduate education.
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