Covid-19 CasesTo rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations for evaluation or treatment. In the interest of timeliness, these reports are evaluated by in-house editors, with peer review reserved for key points as needed.

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is an active worldwide pandemic with diverse complications. Stroke as a presentation has not been strongly associated with COVID-19. The authors aimed to retrospectively review a link between COVID-19 and acute stroke. MATERIALS AND METHODS: We conducted a retrospective case-control study of 41 cases and 82 control subjects matched by age, sex, and risk factors. Cases were patients who underwent stroke alert imaging with confirmed acute stroke on imaging between March 16 and April 5, 2020, at 6 hospitals across New York City. Control subjects were those who underwent stroke alertimaging during the same timeframe without imaging evidence of acute infarction. Data pertaining to diagnosis of COVID-19 infection, patient demographics, and risk factors were collected. A univariate analysis was performed to assess the covariate effect of risk factors and COVID-19 status on stroke imaging with positive findings.

Background and Purpose: The 2019 novel coronavirus outbreak and its associated disease (coronavirus disease 2019 [COVID-19]) have created a worldwide pandemic. Early data suggest higher rate of ischemic stroke in severe COVID-19 infection. We evaluated whether a relationship exists between emergent large vessel occlusion (ELVO) and the ongoing COVID-19 outbreak. Methods: This is a retrospective, observational case series. Data were collected from all patients who presented with ELVO to the Mount Sinai Health System Hospitals across New York City during the peak 3 weeks of hospitalization and death from COVID-19. Patients’ demographic, comorbid conditions, cardiovascular risk factors, COVID-19 disease status, and clinical presentation were extracted from the electronic medical record. Comparison was made between COVID-19 positive and negative cohorts. The incidence of ELVO stroke was compared with the pre-COVID period. Results: Forty-five consecutive ELVO patients presented during the observation period. Fifty-three percent of patients tested positive for COVID-19. Total patients’ mean (±SD) age was 66 (±17). Patients with COVID-19 were significantly younger than patients without COVID-19, 59±13 versus 74±17 (odds ratio [95% CI], 0.94 [0.81–0.98]; P =0.004). Seventy-five percent of patients with COVID-19 were male compared with 43% of patients without COVID-19 (odds ratio [95% CI], 3.99 [1.12–14.17]; P =0.032). Patients with COVID-19 were less likely to be White (8% versus 38% [odds ratio (95% CI), 0.15 (0.04–0.81); P =0.027]). In comparison to a similar time duration before the COVID-19 outbreak, a 2-fold increase in the total number of ELVO was observed (estimate: 0.78 [95% CI, 0.47–1.08], P ≤0.0001). Conclusions: More than half of the ELVO stroke patients during the peak time of the New York City’s COVID-19 outbreak were COVID-19 positive, and those patients with COVID-19 were younger, more likely to be male, and less likely to be White. Our findings also suggest an increase in the incidence of ELVO stroke during the peak of the COVID-19 outbreak.

Background and Purpose-Both initial hematoma volume and hematoma growth are independent predictors of clinical outcomes and mortality among intracerebral hemorrhage patients. The purpose of this study was to evaluate the accuracy of different computed tomography image acquisition protocols and hematoma volume measurement techniques. Methods-We used plastic and cadaveric phantoms to determine the accuracy of different volumetric measurement techniques. We performed both axial and spiral computed tomography scans with 0.75-, 1.5-, 3.0-, and 4.5-mm-thick transverse sections (with no gap). Different measurement techniques (planimetry, ABC/2, and 3D rendering) and different window width/level settings (I, 150/50 versus II, 587/Ϫ321) were used to assess generated errors in volumetric calculations. 4 Later on, a simplified version of the ellipsoid equation, known as ABC/2 or XYZ/2, has been used. 2,5,6 Even though other methods for hematoma volume calculations have been proposed after the ABC/2 method, published studies have been limited regarding the role of image acquisition protocols, such as slice thickness, in the accuracy of volumetric measurements of hematoma. The purpose of this study was to evaluate the accuracy of different computed tomography (CT) protocols and hematoma volume measurement techniques. We used silicone and cadaveric phantoms to determine the accuracy of commonly used imaging techniques in measuring predetermined volumes. Results-Both Materials and Methods Silicone PhantomWe scanned 6 arbitrarily shaped solid-silicone phantoms of different volumes (ranging from 9.47 to 68.42 mL) by using a multichannel/ multidetector CT scanner (Sensation 64, Siemens Healthcare, Erlangen, Germany). The volumes of silicone objects were determined by measuring the volume of water displaced by the phantoms in a filter flask.Image acquisition was performed for axial and spiral CT protocols with a 0.75-mm (with no gap) slice thickness. The scanned objects were also reconstructed in 1.5-, 3.0-, and 4.5-mm-thick transverse sections. For volume estimation, we used different methods, including planimetry, 3D volume rendering, ABC/2, and ABC/2 with adjusted C values. The ABC/2 method is based on the volume of an ellipsoid that is approximately equal to ABC/2 (when the value of is approximated to 3). In this formula, A represents maximum length measured on the slice with the largest area, B represents maximum width perpendicular to A on the same slice, and C represents the number of slices in which the hematoma is visualized multiplied by the slice thickness. In the ABC/2 adjusted method, C values were calculated as described previously by Kothari et al. 7 We used Medical Image Processing, Analysis, and Visualization (Center for Information Technology, National Institutes of Health, Bethesda, MD) software for performing planimetry measurements. Image segmentation and volume rendering were performed by using 2 commercially available packages (Analyze 10; Analyze Direct, Inc, Overland Park, KS, and Voxar 3D, Barco NV,...

An average attenuation <50 HU of the most hyperattenuating hyperdense parenchymal lesion on immediate post-procedural CT scan was very specific for differentiating contrast extravasation from intraparenchymal hemorrhage in acute ischemic stroke patients after endovascular treatment.