Emergency room neurology in times of COVID‐19: malignant ischaemic stroke and SARS‐CoV‐2 infection

González‐Pinto, Tirso; Luna‐Rodríguez, Alain; Moreno‐Estébanez, Ana; Agirre‐Beitia, Garazi; Rodríguez‐Antigüedad, Alfredo; Ruiz-López, Marta

doi:10.1111/ene.14286

Cited by 93 publications

(90 citation statements)

References 4 publications

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“…1,20,21 The pathophysio logical mechanisms that underlie cerebrovascular events in COVID19 require further study, but there is a potential biological rationale for a vasculopathy, with a report of SARSCoV2 endothelitis in organs outside the cerebral vasculature 22 and cerebrovascular events, 23 in addition to coagulopathy, along with conventional stroke risk during sepsis. 9,24,25 Comprehensive studies with clear control groups, including patients hospi talised with COVID19 but without cerebrovascular events and patients with cerebrovascular events but who do not have COVID19, are required to address this issue.…”

Section: Discussionmentioning

confidence: 99%

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Varatharaj

Thomas

Ellul

et al. 2020

The Lancet Psychiatry

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Background Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain. Methods During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies.

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Section: Discussionmentioning

confidence: 99%

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Varatharaj

Thomas

Ellul

et al. 2020

The Lancet Psychiatry

1,123

1,005

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“…Although the mean age of patients with COVID-19 and stroke in our review was 62.9 years, many case series and case reports have shown that those in the younger age group or those with no comorbidities more commonly presented with stroke ( 42 , 43 , 49 , 50 , 53 , 56 , 58 ). Furthermore, stroke is shown to occur early in the illness with mean onset at 6.9 days, with reports even showing that patients may present with stroke and at the same time have asymptomatic COVID-19 infection ( 42 , 49 ).…”

Section: Discussionmentioning

confidence: 80%

“…A total sample of 8,771 participants was included in the systematic review. These studies were conducted in many countries worldwide including in China ( 13 , 40 , 43 ), France ( 37 , 39 , 48 , 50 ), India ( 42 ), Iran ( 51 ), Italy ( 32 , 33 , 46 ), the Netherlands ( 34 ), Philippines ( 52 ), Spain ( 44 , 53 ), Turkey ( 58 ), UK ( 41 , 55 ), and the USA ( 21 , 35 , 36 , 45 , 47 , 49 , 54 , 56 , 57 ). Out of 27 studies, eight studies were of retrospective cohort study design, 11 were case series, and nine were case reports.…”

Section: Resultsmentioning

confidence: 99%

“…The numbers of stroke were almost equal for LVO (47 stroke cases in 10 studies) and non-LVO (42 cases in 10 studies). Location of LVOs involved were M1 vessels ( 21 , 37 , 41 , 42 , 44 , 45 , 47 , 53 , 54 ), M2 vessel ( 41 , 42 , 44 , 45 , 47 , 53 ), internal carotid ( 21 , 37 , 42 , 45 , 47 , 53 ), multiteritorial ( 37 , 47 ), posterior cerebral ( 41 , 45 ), basilar ( 37 ), ACA ( 21 , 53 ), and the vertebral artery ( 41 ).…”

Section: Resultsmentioning

confidence: 99%

“…Unfortunately, patients with COVID-19 and stroke had a more severe COVID-19 infection and a poorer prognosis with a higher mortality rate as shown by this current review. The mean mortality rate among stroke patients with COVID-19 infection was 46.7% compared to only 8.7% among those without COVID-19 infection, and this could be attributed to the severity of infections in patients concurrently having neurological complications ( 13 , 53 , 54 , 56 ).…”

Section: Discussionmentioning

confidence: 96%

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Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

et al. 2020

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Background: As the world witnessed the devastation caused by the coronavirus disease 2019 (COVID-19) outbreak, a growing body of literature on COVID-19 is also becoming increasingly available. Stroke has increasingly been reported as a complication of COVID-19 infection. However, a systematic synthesis of the available data has not been conducted. Therefore, we performed a systematic review and meta-analysis of currently available epidemiological, clinical, and laboratory data related to both stroke and COVID-19 infection. Methods: We systematically searched Medline, Cinahl, and PubMed for studies related to stroke and COVID-19 from inception up to June 4, 2020. We selected cohort studies, case series, and case reports that reported the occurrence of stroke in COVID-19 patients. A fixed-effects model was used to estimate the pooled frequency of stroke in COVID-19 patients with a 95% confidence interval (CI). Results: Twenty-eight studies were included in the systematic review and seven studies for the meta-analysis. The pooled frequency of stroke in COVID-19 patients was 1.1% (95% CI: 0.8, 1.3). The heterogeneity was low ( I 2 = 0.0%). Even though the frequency of stroke among patients having COVID-19 infection was low, those with concomitant COVID-19 infection and stroke suffered from a more severe infection and eventually had a poorer prognosis with a higher mortality rate (46.7%) than COVID-19 alone. Many COVID-19 patients shared the common traditional risk factors for stroke. We noted that ischemic stroke involving the anterior circulation with large vessels occlusion is the most common type of stroke with more strokes seen in multi-territorial regions, suggesting systemic thromboembolism. An elevated level of D-dimers, C-reactive protein, ferritin, lactic acid dehydrogenase, troponin, ESR, fibrinogen, and a positive antiphospholipid antibody were also noted in this review. Conclusions: The occurrence of stroke in patients with COVID-19 infection is uncommon, but it may pose as an important prognostic marker and indicator of severity of infection, by causing large vessels occlusion and exhibiting a thrombo-inflammatory vascular picture. Physicians should be made aware and remain vigilant on the possible two-way relationship between stroke and COVID-19 infection. The rate of stroke among patients with COVID-19 infection may increase in the future as they share the common risk factors.

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Neurological complications of COVID-19: a preliminary review

2020

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Emergency room neurology in times of COVID‐19: malignant ischaemic stroke and SARS‐CoV‐2 infection

Cited by 93 publications

References 4 publications

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

Neurological complications of COVID-19: a preliminary review

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