Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

Abootalebi, Shahram; Aertker, Benjamin M.; Andalibi, Mohammad Sobhan Sheikh; Asdaghi, Negar; Aykaç, Özlem; Azarpazhooh, M. Reza; Bahit, M. Cecilia; Barlinn, Kristian; Basri, Hamidon; Shahripour, Reza Bavarsad; Bersano, Anna; Biller, José; Borhani‐Haghighi, Afshin; Brown, Robert D.; Campbell, Bruce; Cruz‐Flores, Salvador; Silva, Deidre Anne De; Napoli, Mario Di; Divani, Afshin A.; Edgell, Randall C.; Fifi, Johanna T; Ghoreishi, Abdoreza; Hirano, Teruyuki; Hong, Keun Sik; Hsu, Chung Y.; Huang, Josephine F.; Inoue, Matsuhisa; Jagolino, Amanda; Kapral, Moira K.; Hoo, Fan Kee; Keser, Zafer; Khatri, Rakesh; Koga, Masatoshi; Krupiński, Jerzy; Liebeskind, David S; Liu, Liping; Ma, Henry; Maud, Alberto; McCullough, Louise D.; Meyer, Dawn M; Mifsud, Victoria; Morovatdar, Negar; Nilanont, Yongchai; Oxley, Thomas J.; Özdemi̇r, Atilla Özcan; Pandian, Jeyaraj D.; Pantoni, Leonardo; Papamitsakis, Nikolaos; Parry‐Jones, Adrian; Phan, Thanh G.; Rodríguez, Gustavo J.; Romano, José G.; Sabaa-Ayoun, Ziad; Saber, Hamidreza; Sasannezhad, P; Saver, Jeffrey L.; Scharf, Eugene; Shuaib, Ashfaq; Silver, Brian; Singhal, Shaloo; Smith, Craig J.; Stranges, Saverio; Sylaja, PN; Torbey, Michel T.; Toyoda, Kazunori; Tsivgoulis, Georgios; Wasay, Mohammad; Yassi, Nawaf; Yoshimoto, Takeshi; Zamani, Babak; Zand, Ramin

doi:10.1016/j.jstrokecerebrovasdis.2020.104938

Cited by 28 publications

(37 citation statements)

References 23 publications

(28 reference statements)

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“…Future studies such as CASCADE (Call to Action: SARS-CoV-2 and Cerebrovascular DisordErs) are required to shed light on changes in stroke care protocols and hospitalization rate during the pandemic. [84] Our study reported patients with intracranial hemorrhage. Among the patients with SAH-23, no aneurysm was detected in 69.5% patients, which is higher than reported 15%(5%-34%) spontaneous SAH among patients without SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 86%

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

Shahjouei

Tsivgoulis

Farahmand

et al. 2020

Preprint

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Background: Stroke is reported as a consequence of SARS-CoV-2 infection. However, there is a lack of regarding comprehensive stroke phenotype and characteristics Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients. We further investigated the association of demographics, clinical data, geographical regions, and countrie's health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. Conclusions: We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. Among hospitalized patients, the stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.

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Section: Discussionmentioning

confidence: 86%

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

Shahjouei

Tsivgoulis

Farahmand

et al. 2020

Preprint

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“…Increased risk of adverse outcomes and patient safety in hospitalized cases with dementia has been a challenging condition even prior ot COVID-19 pandemic [31]. A high mortality rate of COVID-19 among demented patients could be partially explained by ageing and chronic comorbidities, particularly cardio or cerebr-vascular diseases [32,33]. In addition, using the UK Biobank databasebase and after adjusting for pre-existing dementia, cardiovascular diseases, and type-2 diabetes, Kuo et al showed that the ApoE e4e4 allele is associated with severe COVID-19 infection [34].…”

Section: Discussionmentioning

confidence: 99%

Correlations between COVID-19 and burden of dementia: An ecological study and review of literature

Azarpazhooh

Amiri

Morovatdar

et al. 2020

Journal of the Neurological Sciences

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Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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“…The CASCADE (Call to Action: SARS-Cov-2 and CerebrovAscular DisordErs) study is a worldwide, multicentre hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. 45 The main aim of this study is to enable the understanding of the changes in models of stroke care, differential hospitalization rate, and stroke severity, as it pertains to the COVID-19 pandemic.…”

Section: What Are the Preliminary Data Of The Current Sars-cov-2 Outbmentioning

confidence: 99%

“…5 In light of those data, several stroke centres have come together to design a study protocol with the aim to investigate the worldwide burden of cerebrovascular disease before, during and after SARS-CoV-2 pandemic (CASCADE study). 45 In addition, stroke centres have been guided to implement a 'protected code stroke' for the management of acute stroke patients. 50,52 'Protected code stroke' actually originates from the acknowledgment that every stroke patient is potentially infected and should be treated accordingly.…”

Section: What Is the Impact Of Covid-19 Pandemic On The Health Care Omentioning

confidence: 99%

Neurological manifestations and implications of COVID-19 pandemic

Tsivgoulis

Palaiodimou

Katsanos

et al. 2020

Ther Adv Neurol Disord

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The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China and rapidly spread worldwide, with a vast majority of confirmed cases presenting with respiratory symptoms. Potential neurological manifestations and their pathophysiological mechanisms have not been thoroughly established. In this narrative review, we sought to present the neurological manifestations associated with coronavirus disease 2019 (COVID-19). Case reports, case series, editorials, reviews, case-control and cohort studies were evaluated, and relevant information was abstracted. Various reports of neurological manifestations of previous coronavirus epidemics provide a roadmap regarding potential neurological complications of COVID-19, due to many shared characteristics between these viruses and SARS-CoV-2. Studies from the current pandemic are accumulating and report COVID-19 patients presenting with dizziness, headache, myalgias, hypogeusia and hyposmia, but also with more serious manifestations including polyneuropathy, myositis, cerebrovascular diseases, encephalitis and encephalopathy. However, discrimination between causal relationship and incidental comorbidity is often difficult. Severe COVID-19 shares common risk factors with cerebrovascular diseases, and it is currently unclear whether the infection per se represents an independent stroke risk factor. Regardless of any direct or indirect neurological manifestations, the COVID-19 pandemic has a huge impact on the management of neurological patients, whether infected or not. In particular, the majority of stroke services worldwide have been negatively influenced in terms of care delivery and fear to access healthcare services. The effect on healthcare quality in the field of other neurological diseases is additionally evaluated.

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Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

Abstract: tized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Cited by 28 publications

References 23 publications

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

Correlations between COVID-19 and burden of dementia: An ecological study and review of literature

Neurological manifestations and implications of COVID-19 pandemic

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