BACKGROUND Primary headache especially migraine ranks among the top 20 causes of the disease burden as per the years lived with disability (YLD) criteria.1 Stress due to many factors during the COVID-19 pandemic can worsen the migraine symptoms and reduce the therapeutic response.2,3 In this study, we aimed to investigate this impact on migraine frequency and severity on medical care, in addition to overall psychosocial health and specific COVID-19 (Coronavirus Disease 2019) concerns among migraine patients. METHODS A questionnaire based telephonic survey was used to collect details about the impact of COVID-19 on patients with migraine who visited our outpatient clinic from 1st January 2019 to 31st December 2019. Telephonic interview was carried out by the investigators from July 5th to August 15th of 2021. RESULTS A total of 320 patients participated in the survey. Women constituted 79.7% of the study population and, 39.7% were between 40-60 years while 34.1% were between 20-40 years of age. In comparison to the pre-pandemic period, 56.9% of patients reported increase in the severity of migraine and 55.9% reported increase in the number of headache-days. Difficulties in accessing headache medications was reported by 73.4% and, 75.3% were not able to follow their medication schedule. Only 57.2% were able to access specialist care during the pandemic. Overuse of analgesics was reported by 15.9% of participants in the pre-pandemic period, while it increased to 37.8% after the pandemic. Sleep disturbances, anxiety and depression were reported by 47.2% and increase in screen-time exposure was mentioned by 41.9%. CONCLUSIONS COVID-19 pandemic has caused a significantly negative impact on patients with migraine. Well planned strategies should be implemented to ensure availability of quality care for patients with migraine, with emphasis on psychosocial well-being. KEY WORDS COVID-19, Migraine, Primary Headache.
Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological diagnosis characterized by acute or subacute neurological symptoms. A 27-year-old woman at 35 weeks of pregnancy, who presented with generalized tonic-clonic seizures had persistently low Glasgow Coma Scale (GCS) score after delivery of the baby. Magnetic Resonance Imaging (MRI) of the brain showed T-2 Fluid Attenuated Inversion Recovery (FLAIR) hyperintensities in the brainstem, bilateral medial cerebellar hemispheres, bilateral medial temporal lobes, bilateral thalami, lentiform and caudate nuclei, and bilateral fronto-parieto-occipital lobes. There was diffusion restriction in bilateral caudate nuclei, left thalamus and right frontal lobe, and microhemorrhages in the left thalamus. These findings were suggestive of central variant PRES. She improved with strict blood pressure control and anti-edema measures. A repeat MRI brain on day 10 showed significant improvement, and she had no residual neurological deficits. The central variant of PRES is a rare entity that has to be considered in a patient presenting with neurological deficits in the setting of uncontrolled blood pressure, eclampsia, immunomodulatory medication use, or renal failure. While most patients with PRES fully recover with timely therapy targeted at reversing the primary cause, some may have residual neurological deficits or rarely, die.
BACKGROUND COVID-19 is associated with a hypercoagulable state and stroke is one of its most common neurological complications. The current study is aimed at investigating the effect of the COVID-19 pandemic on hospital admissions for stroke. METHODS We conducted a retrospective observational study to determine if there was a significant difference in the number of hospital admissions for stroke during the 2 months of lockdown and the two preceding months, (starting on 24 March 2020). The numbers were also compared with the figures during the same months in the previous year. The numbers were also compared to the same months one year prior. The secondary objectives were to compare the time between the onset of stroke and presentation to the hospital, type of strokes that presented to the hospital, severity of stroke, number of code activations, number of thrombolysis conducted, and in-hospital mortality between the same time periods. RESULTS The total number of patients admitted for stroke during the time periods from 25th March 2019 to 24th May 2019, 25th January 2020 to 24th March 2020 and 25th March 2020 to 24th May 2020 were 82, 72 and 75 respectively, and there was no statistically significant difference between these numbers. However, there was a significant increase in the proportion of stroke cases when compared to total hospital admissions. This suggests that an increase in stroke incidence may have been masked by a reduction in the total number of patients presenting to the hospital. The National Institutes of Health Stroke Scale (NIHSS) score of the patients who presented during the lockdown were higher. There were no significant differences in the time between the onset of stroke and presentation to the hospital, type of strokes that presented to the hospital, severity of stroke, number of code activations, number of thrombolysis conducted, and in-hospital mortality between the periods under study. CONCLUSIONS The present study suggests that there may be a relative increase in the incidence of stroke in the community, as a result of the COVID-19 pandemic. The patients who presented with stroke during the lockdown period had a higher NIHSS score. KEYWORDS COVID-19, Stroke, Lockdown
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